Arrhythmogenic potential develops rapidly at graft reperfusion before the start of hypotension during living-donor liver transplantation.
10.4097/kjae.2016.69.1.37
- Author:
Hwa Mi LEE
1
;
Soo Kyoung PARK
;
Young Jin MOON
;
Jung Won KIM
;
Sun Key KIM
;
Bo Hyun SANG
;
Dong Kyun SEO
;
Byoung Woo YOO
;
Gyu Sam HWANG
Author Information
1. Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kshwang@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Arrythmia;
Electrocardiography;
Hypothermia;
Liver transplantation;
Reperfusion
- MeSH:
Arrhythmias, Cardiac;
Arterial Pressure;
Catheters;
Electrocardiography;
Humans;
Hypotension*;
Hypothermia;
Liver Transplantation*;
Liver*;
Medical Records;
Portal Vein;
Reperfusion*;
Retrospective Studies;
Transplants*
- From:Korean Journal of Anesthesiology
2016;69(1):37-43
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Detailed profiles of acute hypothermia and electrocardiographic (ECG) manifestations of arrhythmogenicity were examined to analyze acute hypothermia and ventricular arrhythmogenic potential immediately after portal vein unclamping (PVU) in living-donor liver transplantation (LT). METHODS: We retrospectively analyzed electronically archived medical records (n = 148) of beat-to-beat ECG, arterial pressure waveforms, and blood temperature (BT) from Swan-Ganz catheters in patients undergoing living-donor LT. The ECG data analyzed were selected from the start of BT drop to the initiation of systolic hypotension after PVU. RESULTS: On reperfusion, acute hypothermia of < 34degrees C, < 33degrees C and < 32degrees C developed in 75.0%, 37.2% and 11.5% of patients, respectively. BT decreased from 35.0degrees C +/- 0.8degrees C to 33.3degrees C +/- 1.0degrees C (range 35.8degrees C-30.5degrees C). The median time to nadir of BT was 10 s after PVU. Difference in BT (DeltaBT) was weakly correlated with graft-recipient weight ratio (GRWR; r = 0.22, P = 0.008). Compared to baseline, arrhythmogenicity indices such as corrected QT (QTc), Tp-e (T wave peak to end) interval, and Tp-e/QTc ratio were prolonged (P < 0.001 each). ST height decreased and T amplitude increased (P < 0.001 each). However, no correlation was found between DeltaBT and arrhythmogenic indices. CONCLUSIONS: In living-donor LT, regardless of extent of BT drop, ventricular arrhythmogenic potential developed immediately after PVU prior to occurrence of systolic hypotension.
