We study the efficacy of Norepinephrine boluses on prevention of postreperfusion syndrome
during living donor liver transplantation.
NE and Post-reperfusion:
On portal vein declamping, we will start rapid 500 ml 4% albumin infusion or packed RBCs
(according to the anhepatic hemoglobin level 5 min before declamping) through 14 Gauge
peripheral venous cannula in all patients.
NE boluses technique; We will inject NE boluses in the C.V.P port of the pulmonary artery
catheter with 5 ml saline flushing after each. After reperfusion, we will start bolus
noradrenaline 20 µg if mean arterial blood pressure (mABP) decreases by 10 % or more of the
basal reading (immediately before portal vein declamping after ensuring withholding of the
surgical manipulation). Additional NE boluses will be given as follow;
- If mABP rises to 65 mmHg (lowest target level), we will hold NE boluses.
- If mABP remains constant or begins to rise but did not reach 65 mmHg, we will give 20 µg
after 10 seconds from the previous bolus
- If mABP continues to drop, we will add 10 µg to the previous dose after 10 seconds and
can be repeated.
- If mABP remains below 65 mmHg more than 1 minute, we will give the scheduled bolus NE
with adding 20 µg adrenaline boluses.