Correlation between radial and femoral arterial blood pressure during reperfusion in living donor liver transplantation

Manu Thomas; Lakshmi Kumar; Priyanka Jain; Chitra Sarma; Shabala Paul; Sudhindran Surendran

doi:10.4103/ija.IJA_495_20

Correlation between radial and femoral arterial blood pressure during reperfusion in living donor liver transplantation

Indian J Anaesth. 2021 Apr;65(4):302-308. doi: 10.4103/ija.IJA_495_20. Epub 2021 Apr 15.

Authors

Manu Thomas¹, Lakshmi Kumar¹, Priyanka Jain², Chitra Sarma¹, Shabala Paul¹, Sudhindran Surendran³

Affiliations

¹ Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
² Department of Clinical Research, Institute of Liver and Biliary Sciences, Delhi, India.
³ Department of Gastro Intestinal Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.

Abstract

Background and aims: Accurate blood pressure measurements are the mainstay for the efficient management of abrupt cardiovascular changes during reperfusion in liver transplant. We sought to compare the femoral and radial pressures during reperfusion and at T1:baseline, T2: 1 h in dissection: T3:portosystemic shunt, T4:reperfusion, T5: at bile duct anastomosis.

Methods: A retrospective study was performed amongst 102 adult patients who underwent R lobe living donor liver transplantation. Mean arterial pressure (MAP) and systolic arterial pressure (SAP) at 10 s intervals at reperfusion and at five fixed time points were compared by intraclass correlation coefficient (ICC) and limits of agreement by Bland-Altman statistics.

Results: MAP by both routes had a good correlation at all time points during reperfusion (overall ICC: 0.946 [0.938, 0.949]) in comparison with SAP (overall ICC: 0.650 [0.6128, 0.684]). At the lowest reperfusion pressure (reperfusion point), MAP showed high levels of agreements (ICC: 0.833 [0.761, 0.885]), whereas SAP showed only a poor level of agreement (ICC 0.343 [0.153, 0.508]). The Bland-Altman analysis for MAP showed a bias of 7.18 (5.94) mmHg and limits of agreement of - 4.5 mmHg to + 18.8 mmHg and for SAP a bias of 25.2 (22.04) mmHg and limits of agreement of - 18.0 mmHg to + 68.4 mmHg at the reperfusion point. The incidence of post-reperfusion syndrome (PRS) was 52.94% by femoral and 57.84% by radial routes.

Conclusions: Radial MAP correlated well with femoral MAP during reperfusion and at predefined time points and can be used interchangeably for intraoperative monitoring. A high incidence of PRS was noted by our technique of measurement.

Keywords: Blood pressure; femoral artery; liver transplant; radial artery; reperfusion.