Evaluation of the right ventricular ejection fraction during orthotopic liver transplantation under propofol anaesthesia

Abstract

Background: The right ventricular ejection fraction pulmonary artery catheter (RVEF-PAC) has been widely used to monitor the right ventricular (RV) function during orthotopic liver transplantation (OLT). However, the evaluation of the RVEF during this procedure during propofol anaesthesia has not been described. Methods: Twenty consecutive patients undergoing OLT without veno-venous bypass were studied. Anaesthesia was maintained with propofol, remifentanil and atracurium infusions. All patients were monitored with a modified pulmonary artery catheter (RVEF-PAC), which continuously measures the RVEF. Haemodynamic data were recorded at: baseline (TB), anhepatic stage (TA), and 1, 5, 10, and 30 min post-reperfusion of the graft. Results: The baseline RVEF was decreased [40% (sd 6)] and remained so throughout the OLT. A biphasic pattern was revealed, with the RVEF reaching its lowest values during TA [34% (7)] and gradually returning toward baseline at T30 [39% (8)]. Clinical significant RV dysfunction did not occur. Conclusions: Although the baseline RVEF was decreased, it showed only minor alterations throughout the procedure, suggesting that the RV function is not significantly compromised during OLT under propofol anaesthesia. © The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved.