title: Effect of mannitol on postreperfusion cardiac output and central venous oxygen saturation during orthotopic liver transplant: a double-blind randomized clinical trial.
abstract: BACKGROUND
  Attenuating postreperfusion syndrome during orthotopic liver transplant is very important for transplant anesthesiologists because of the syndrome's complications. Oxygen-derived free radicals play an important role in the genesis of postreperfusion syndrome, but the effect of mannitol (a free radical scavenger) on attenuating the syndrome is unclear.OBJECTIVES-To investigate the effectiveness of infusing mannitol during the anhepatic phase in preventing postreperfusion syndrome, as indicated by postreperfusion cardiac output and central venous oxygen saturation.
  
  
  METHODS
  In a randomized clinical trial, 53 patients who had undergone orthotopic liver transplant were allocated to 2 groups. During the anhepatic phase, patients in the mannitol group received 1g/kg mannitol, whereas those in the control group received physiological saline. Mean arterial pressure, cardiac output, and central venous oxygen saturation were measured before and after the portal vein was declamped. Serum levels of sodium and potassium were recorded at baseline and after portal vein declamping.Setting-Shiraz Organ Transplant Center, Shiraz, Iran.
  
  
  RESULTS
  In the mannitol group, no significant change was found in mean arterial pressure, cardiac output, and central venous oxygen saturation before and after declamping of the portal vein (P= .78, P= .59, and P= .83, respectively). However, after declamping in the control group, mean arterial pressure, cardiac output, and central venous oxygen saturation were significantly lower than before declamping (P=.003, P=.001, and P<.001, respectively). No significant change in serum levels of sodium and potassium from baseline to after declamping were found in either group.
  
  
  CONCLUSIONS
  Infusion of mannitol 1 g/kg during the anhepatic phase was effective in attenuating postreperfusion syndrome without stress about hyperkalemia or hyponatremia during anesthesia.
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Sahmeddini
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Siamak
authors.initials: S
authors.lastname: Zahiri
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Bagher
authors.initials: MB
authors.lastname: Khosravi
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sina
authors.initials: S
authors.lastname: Ghaffaripour
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Eghbal
authors.affiliation: Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sakine
authors.initials: S
authors.lastname: Shokrizadeh
mesh_terms: D000328:Adult; D002302:Cardiac Output / Q000502:physiology*; D004234:Diuretics, Osmotic / Q000627:therapeutic use*; D004311:Double-Blind Method; D058625:End Stage Liver Disease / Q000097:blood / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008353:Mannitol / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D011659:Pulmonary Gas Exchange / Q000502:physiology; D015427:Reperfusion Injury / Q000517:prevention & control*; D012964:Sodium / Q000097:blood; D055815:Young Adult
chemical_list: D004234:Diuretics, Osmotic; D008353:Mannitol; D012964:Sodium; D011188:Potassium