Intraoperative venesection and isosorbide dinitrate for postreperfusion syndrome during liver transplantation: A case report

Medicine
Ji Hyun KimHyeon Jun Lee

Abstract

Postreperfusion syndrome is the most severe cardiovascular and metabolic alteration which typically occurs after the declamping of the portal vein of the grafted liver during liver transplantation, and it could affect the mortality and morbidity of the patient. We report the case of ischemic change in electrocardiogram with substantial increase of central venous pressure, from 6 to 16 mmHg, that developed immediately after reperfusion. Based on his hemodynamic parameters, it was suspected that this event was caused by sudden volume overload in the right ventricle after reperfusion rather than hypovolemic status, thromboembolism, or any other possibilities. He was treated with active venesection of 300 mL and isosorbide dinitrates infusion at the rate of 30 μg/min. The parameter values were restored to normal within 15 to 20 minutes after treatment, and the patient was discharged postoperatively without any significant cardiac sequelae. Although ischemic ST change during reperfusion reported without any previous cardiac complication is limited, the patient could recover rapidly with careful identification of the cause of PRS and immediate treatment.

References

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Dec 31, 2005·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Luc MassicotteAndré Roy
Sep 29, 2007·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Mi Sook GwakMyung Kim
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Dec 6, 2014·Acta Anaesthesiologica Taiwanica : Official Journal of the Taiwan Society of Anesthesiologists·Bruno JawanSheng-Chun Yang
Dec 4, 2015·Korean journal of anesthesiology·Sung-Moon Jeong
Jan 29, 2016·World Journal of Gastroenterology : WJG·Antonio SiniscalchiStefano Faenza

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