title: Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation.
abstract: Acute hypotension after reperfusion of the liver graft occurs frequently during liver transplantation. A randomized, prospective trial was performed to test the effects of epinephrine and phenylephrine pretreatments for attenuating postreperfusion syndrome (PRS). Ninety-three adult liver recipients were randomly allocated to receive an intravenous bolus of 10 μg of epinephrine, 100 μg of phenylephrine, or normal saline (the control group) at the time of graft reperfusion. The occurrence of PRS, the use of vasoactive drugs, and the postoperative courses were compared. The epinephrine and phenylephrine groups showed PRS less frequently (39% and 48%) than the control group (77%, P = 0.006) as well as higher mean arterial pressures (MAPs) immediately after reperfusion (P < 0.05). An overshoot of MAP was observed in one-third of the pretreated patients with minimal heart rate changes. Only 2 patients in each pretreatment group showed an increase in MAP that was greater than 20% of the baseline value. The intraoperative epinephrine and dopamine requirements were significantly lower in both pretreatment groups. Perioperative laboratory data, postoperative stays, and in-hospital mortality rates were similar for the 3 groups. In conclusion, pretreatment with 10 μg of epinephrine or 100 μg of phenylephrine significantly reduces the occurrence of PRS and vasopressor requirements without immediate or delayed adverse effects in adult liver transplantation.
authors: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors: Ho-Geol
authors: HG
authors: Ryu
authors: Chul-Woo
authors: CW
authors: Jung
authors: Hyung-Chul
authors: HC
authors: Lee
authors: Youn-Joung
authors: YJ
authors: Cho
mesh_terms: D062186:Arterial Pressure / Q000187:drug effects; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D007275:Injections, Intravenous; D007902:Length of Stay; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010656:Phenylephrine / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D056910:Republic of Korea; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D004837:Epinephrine