Showing papers on "Hyperdynamic circulation published in 2013"
TL;DR: The anaesthetic management of patients with hepatic dysfunction involves consideration of impaired drug metabolism, hyperdynamic circulation, perioperative hypoxaemia, bleeding, thrombosis, and hepatic encephalopathy.
Abstract: Patients with liver disease have multisystem organ dysfunction that leads to physiological perturbations ranging from hyperbilirubinaemia of no clinical consequence to severe coagulopathy and metabolic disarray Patient-specific risk factors, clinical scoring systems, and surgical procedures stratify perioperative risk for these patients The anaesthetic management of patients with hepatic dysfunction involves consideration of impaired drug metabolism, hyperdynamic circulation, perioperative hypoxaemia, bleeding, thrombosis, and hepatic encephalopathy
41 citations
TL;DR: The renal effects of TIPS seem to be beneficial as renal function tends to improve in patients with the hepatorenal syndrome, and studies on the central haemodynamic effects are warranted to refine the already applied treatments and develop new treatment modalities.
Abstract: Refractory ascites and recurrent variceal bleeding are among the serious complications of portal hypertension and cirrhosis for which a transjugular intrahepatic portosystemic shunt (TIPS) can be used. Cirrhotic patients have varying degrees of haemodynamic derangement, mainly characterized by peripheral arterial vasodilatation, central underfilling and activation of several vasoactive systems. These changes affect the heart, the lungs and the kidneys in particular. The cardiac effects of TIPS are immediate and are related to the redirection of blood from the splanchnic circulation into the systemic circulation, resulting in worsening of the hyperdynamic circulation with increasing cardiac output and decreasing systemic vascular resistance; further, TIPS may unmask a latent diastolic dysfunction of the heart. However, the renal effects of TIPS seem to be beneficial as renal function tends to improve in patients with the hepatorenal syndrome. The clinical and haemodynamic effects of TIPS have been studied intensively and will be reviewed in the present paper. Considerable knowledge on the effects of TIPS on the pathophysiology of cirrhosis has been gained, but studies on the central haemodynamic effects are warranted to refine the already applied treatments and develop new treatment modalities.
30 citations
Journal Article•
TL;DR: MELD score was an independent predictor of HC, and beta-blockers resulted associated with lower incidence of HC in cirrhotic patients undergoing cadaveric OLT.
Abstract: BACKGROUND Liver cirrhosis is associated with a hyperdynamic circulation (HC) In this observational study, we aimed to investigate the predictive factors of HC, its impact on intraoperative hemodynamic and postoperative outcome, early ICU and in-hospital mortality, in cirrhotic patients undergoing orthotopic liver transplantation (OLT) METHODS Two hundred and forty-two patients with cirrhosis undergoing cadaveric OLT were included Before starting the transplant procedure and under general anesthesia, a pulmonary artery catheter was introduced to assess hemodynamic parameters The baseline assessment was carried out approximately 30 minutes after the catheter placement and repeated during the anhepatic phase, 10 minutes after the reperfusion and at the end of surgery The patients were divided into two groups: in group 1 the patients had SVR>900dynes s-1 m-2 cm-5, in group 2 SVR ≤900 dynes s-1 m-2 cm-5 RESULTS Eighty-two patients (33%) presented severe HC In multivariate analysis 2 factors were associated with the occurrence of HC: beta-blockers use (Exp [B]=442 (95% CI 118-17); P=0001, [34% and 12% in groups 1 and 2, P<0001, respectively]) and model for end-stage liver disease (MELD) score (Exp [B]=1066; 95% CI=1025-1109; P=0001) CONCLUSION MELD score was an independent predictor of HC, and beta-blockers resulted associated with lower incidence of HC in cirrhotic patients undergoing cadaveric OLT Intraoperative HC correlates with hemodynamic alterations, requiring more blood products and vasopressor use, this may increase the risk of renal failure, early ICU death and in-hospital mortality
19 citations
TL;DR: A diabetic patient with advanced cirrhosis and sepsis usually has markedly increased capillary permeability, high hydrostatic pressure due to hyperdynamic circulation, and compromised lymphatic drainage capacity, so using albumin infusion in them would not only fail to improve relative hypovolemia, but also would deleteriously promote extravascular accumulation of fluid, which might impair the functions of many vital organs.
9 citations
TL;DR: Treatment with estrogen improved the systemic and splanchnic hyperdynamic circulation in PPVL rats, in part due to the alleviation of oxidative stress.
Abstract: Estrogen improves the hyperdynamic circulation and hyporeactivity of mesenteric arteries by alleviating oxidative stress in partial portal vein ligated rats
6 citations
TL;DR: Watch a video presentation of this article: The next generation of smart phones will be able to recognise each other's voices and provide real-time information about the person they are trying to communicate with.
6 citations
TL;DR: The key features are normal cardiac pressures at rest, with reduced ability to compensate for physiological or iatrogenic stresses such as drug therapy or TIPSS.
Abstract: Hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PoPH) are two fascinating and incompletely understood pulmonary vascular conditions seen in the setting of cirrhotic patients. Of the two HPS is more common and is primarily caused by pulmonary vasodilatation resulting in hypoxaemia and hyperdynamic circulation. PoPH is less common and conversely, pulmonary vasoconstriction and vascular remodelling occurs resulting in increased pulmonary vascular resistance. However, both conditions can co-exist and it is usually PoPH which develops in a patient with pre-existing HPS. Although these two pulmonary conditions are not common complications of chronic liver diseases, the treatment options are mainly limited to liver transplantation. Cirrhotic cardiomyopathy is closely related to haemodynamic changes in portal hypertension. The key features are normal cardiac pressures at rest, with reduced ability to compensate for physiological or iatrogenic stresses such as drug therapy or TIPSS. There is no effective therapy and outcomes after liver transplantation are variable.
4 citations
Journal Article•
TL;DR: The role that the endocannabinoids and their receptors could play in the pathogenesis of the cirrhotic cardiomyopathy, as well as on the treatment options that they offer are focused on.
Abstract: It has been known for over half a century that liver cirrhosis is associated with abnormal cardiovascular function. Although the mechanisms underlying the association of portal hypertension and hyperdynamic circulation have been intensively investigated during the past decades, the results are still inconclusive. This review focuses on the role that the endocannabinoids and their receptors could play in the pathogenesis of the cirrhotic cardiomyopathy, as well as on the treatment options that they offer.
3 citations
TL;DR: Both antioxidant and antiinflammatory effects of Quercetin offer degree of protection for fundic mucosa, therefore, it may protect from gastropathy resulted from PHT.
Abstract: IntroductionPortal hypertension (PHT) is a hyperdynamic circulation disorder. Its precise effect on the fundic mucosa remains a matter of controversy.Aim of studyEvaluation of the effect of long –term experimental induction of PHT on the rat fundic mucosa and the possible protective role of querceti
2 citations