Atropine prophylaxis of the postreperfusion syndrome in liver transplantation

Acosta, F; Sansano, T; Contreras, Rafael; Reche, M; Beltran, R; Roqués, V; Rodríguez, M.A; Robles, R; Bueno, F.S; Ramírez, P.; Parrilla, Pascual

doi:10.1016/s0041-1345(99)00388-7

Cited by 12 publications

(7 citation statements)

References 4 publications

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“…Pretreatment with vasopressors, inhibitors of thromboxane or prostacyclin, atropine, and prostaglandin E 1 has been used to prevent PRS. [21][22][23][24][25] Methods of effective prediction and pretreatment of PRS remain to be established.…”

Section: Discussionmentioning

confidence: 99%

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Nanashima

Pillay

Verran

et al. 2002

Transplantation Proceedings

104

120

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Section: Discussionmentioning

confidence: 99%

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Nanashima

Pillay

Verran

et al. 2002

Transplantation Proceedings

104

120

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“…Therefore, the anticipatory treatment of hypotension with vasoactive agents such as epinephrine and phenylephrine (rather than counteracting specific mediators of PRS) seems more practical 15, 16. Unfortunately, the only published study addressing the prophylactic use of adrenergic agonists to prevent PRS showed that the prophylactic use of atropine prevented the onset of bradycardia but failed to block hypotension 17…”

mentioning

confidence: 99%

Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation

et al. 2012

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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 lg of epinephrine, 100 lg 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 ¼ 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 lg of epinephrine or 100 lg of phenylephrine significantly reduces the occurrence of PRS and vasopressor requirements without immediate or delayed adverse effects in adult liver transplantation. Liver Transpl 18:1430-1439, 2012. V C 2012 AASLD.Received April 30, 2012; accepted July 7, 2012.Acute systemic hypotension frequently occurs immediately after reperfusion of the liver graft during orthotopic liver transplantation surgery. If a greater than 30% decrease in the mean arterial pressure (MAP) lasting more than 1 minute is observed within 5 minutes after reperfusion, postreperfusion syndrome (PRS) is diagnosed. 1 The reported incidence of PRS varies greatly (12%-81%) with the study design. 2-5 Typically, PRS is handled once it occurs instead of being proactively prevented because of its unpredictability and unclear underlying mechanism. However, because of the high incidence of PRS and its associated adverse effects, it seems reasonable to search for preventive measures. 2,4,[6][7][8] The piggyback technique and liver graft flushing are proven surgical prophylaxis methods for reducing PRS. 9-11 Another approach with varying degrees of success is pharmacological pretreatment, which is focused on blocking presumed causes of PRS such as ischemia/reperfusion cascades and their final products. 5,[12][13][14][15] However, previously tested drugs such as nafamostat mesilate, methylene blue, and aprotinin are neither familiar nor currently available to most anesthesiologists. Therefore, the anticipatory treatment of hypotension with vasoactive agents such as epinephrine and phenylephrine (rather than counteracting specific mediators of PRS) seems more practical. 15,16 Unfortunately, the only published study addressing the prophylactic use of adrenergic agonists to preve...

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“…It would seem to be intuitively obvious that any vascular toxins that might be flushed out of the new liver graft would drain directly into the right heart and would be very likely to cause hemodynamic disturbances. Therefore, many different surgical and anesthetic techniques have been developed to minimize the severity of PRS 8–14. This has included flushing the preservation fluid and other vasoactive molecules from the graft prior to reperfusion, adjusting the reperfusion sequence, and also adding some specific pharmacological interventions.…”

mentioning

confidence: 99%

The reperfusion syndrome: Have we made any progress?

Ramsay

2008

Liver Transpl

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Atropine prophylaxis of the postreperfusion syndrome in liver transplantation

Cited by 12 publications

References 4 publications

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Analysis of initial poor graft function after orthotopic liver transplantation: experience of an australian single liver transplantation center

Epinephrine and phenylephrine pretreatments for preventing postreperfusion syndrome during adult liver transplantation

The reperfusion syndrome: Have we made any progress?

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