Norepinephrine Boluses in Liver Transplantation

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 10 µg adrenaline boluses.