Correlation Between Changes in End-Tidal Carbon Dioxide Concentration and Cardiac Output During Inferior Vena Cava Clamping and Unclamping in Living-donor Liver Transplantation.
BACKGROUND
To test the hypothesis that low end-tidal carbon dioxide tension encountered during anhepatic phase in liver transplantation is related to hemodynamic status rather than ventilatory status, and can be used to predict the change in cardiac output during anhepatic phase.


METHODS
We retrospectively analyzed and compared data, included end-tidal carbon dioxide tension (ETCO2), arterial blood pressure, heart rate, central venous pressure, cardiac output, cardiac index, and stroke volume, before and after inferior vena cava clamping, and 0, 5, 10, 30 minutes during the anhepatic, and 5 minutes after the release of IVC cross clamp during the reperfusion phase, with paired Student t test, repeated measurement, and linear regression. P < .05 was regarded as significant.


RESULTS
The cardiac output and ETCO2 decrease significantly after clamping the inferior vena cava and increase concomitantly after unclamping. There is a positive correlation between the changes in % in cardiac output and ETCO2 (Pearson coefficient r = 0.741).


CONCLUSIONS
The changes in ETCO2 can be used to predict the changes of the cardiac output in % when cardiac output monitoring is not available. Before unclamping of the IVC, mild hyperventilation is suggested to prevent excessive increase in PaCO2.
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
T H
TH
Shih
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
C E
CE
Huang
Department of Liver Transplantation Program and Surgery, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
C L
CL
Chen
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
C H
CH
Wang
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
C J
CJ
Huang
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
K W
KW
Cheng
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
S C
SC
Wu
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
S E
SE
Juang
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Y E
YE
Lee
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Z W
ZW
Wong
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
B
B
Jawan
Department of Anesthesiology, Kaohsiung Chang Gung Memorial and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: eternity0602@hotmail.com.
S C
SC
Yang
D000328:Adult; D001784:Blood Gas Analysis; D002245:Carbon Dioxide / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology*; D002496:Central Venous Pressure / Q000502:physiology; D003250:Constriction; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008102:Liver Circulation / Q000502:physiology; D008107:Liver Diseases / Q000097:blood* / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology; D014682:Vena Cava, Inferior / Q000601:surgery*
D002245:Carbon Dioxide