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KMID : 0356920160690010037
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Korean Journal of Anesthesiology
2016 Volume.69 No. 1 p.37 ~ p.43
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Arrhythmogenic potential develops rapidly at graft reperfusion before the start of hypotension during living-donor liver transplantation
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:Lee Hwa-Mi
:Park Soo-Kyoung/:Moon Young-Jin/:Kim Jung-Won/:Sang Bo-Hyun/:Seo Dong-Kyun/:Yoo Byoung-Woo/:Hwang Gyu-Sam/:Kim Sun-Key
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Abstract
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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 < 34℃, < 33℃ and < 32℃ developed in 75.0%, 37.2% and 11.5% of patients, respectively. BT decreased from 35.0℃ ± 0.8℃ to 33.3℃ ± 1.0℃ (range 35.8℃?30.5℃). The median time to nadir of BT was 10 s after PVU. Difference in BT (ΔBT) 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 ΔBT 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.
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KEYWORD
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Arrythmia, Electrocardiography, Hypothermia, Liver transplantation, Reperfusion
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