The Effect of Norepinephrine on Cardiac Output in Patients Undergoing Liver Transplant .

Study Overview
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Brief Summary
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Early administration of NE in liver transplant recipient might enhance cardiac output through an increase in cardiac preload .

Detailed Description
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The derangement of circulatory blood volume in patients with liver cirrhosis makes intraoperative fluid management during liver transplant is challenging . Cirrhotic patients not only have large blood volume but abnormal blood volume distribution, with a substantial fraction of this volume in the splanchnic circulation (. These hemodynamic changes render volume loading in these patients has little impact on CO because a large proportion of infused fluid is shifted to the splanchnic system . In addition, patients with liver cirrhosis is similar to septic patients who have increased total vascular compliance which may cause pooling of blood in venous pool. Several studies in patients with sepsis found that use of low dose vasopressor may convert unstressed blood volume (i.e the amount of blood not causing pressure on the vessels) to stressed volume (i.e additional blood causing a distending pressure on the vascular walls and reflects the effective circulating volume) . However, no previous studies tested the effect of using norepinephrine (NE) on venous return and cardiac preload in patients undergoing liver transplant. An obvious advantage of this possibility is that NE will be used instead of true ﬂuid replacement which may minimize fluid replacement during operation. Recently, a method was described to estimate the changes in intravascular volume and vascular capacitance by calculating mean systemic ﬁlling pressure (MSFP) . MSFP is the driving pressure in venous return, and it allows calculation of the arterial and venous components of systemic vascular resistance .

Official Title
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The Effect of Norepinephrine on Blood Volume Cardiac , Output and Systemic Filling Pressure in Patients Undergoing Liver Transplant .

Conditions
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Liver Transplantation

Intervention / Treatment
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* Drug: Noradrenaline


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All Adults (age > 18 years) patients undergoing living donor liver transplant (LDLT) will be considered for inclusion in the study.. Exclusion Criteria: Patients less than 18 years. Patients undergoing liver transplantation for acute liver failure . All Chronic Hypertensive patients on medication , whether controlled on not controlled Those with high risk of post transplant renal dysfunction (serum creatinine >1.5 mg/dL at time of transplant)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Noradrenaline group<br> | Drug: Noradrenaline<br>* Noradrenaline infusion for patients undergoing liver transplantaion from living donor .<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effect of Noradrenaline on change of cardiac output . | The effect of Noradrenaline on change of cardiac output . | along the procedure ; from skin incision to the end of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The effect of NE on mean systemic filling pressure . | The effect of NE on mean systemic filling pressure . | along the procedure ; from skin incision to the end of surgery | 
| The effect of NE on venous return . | The effect of NE on venous return . | along the procedure ; from skin incision to the end of surgery | 
| The effect of NE on central venous pressure . | The effect of NE on central venous pressure . | along the procedure ; from skin incision to the end of surgery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Liver transplantaion , fluid management , noradrenaline