Arterial waveform monitoring during liver transplantation

Liver transplantation has long been associated with high mortality and morbidity until recent advancement in surgical techniques, perioperative management and the introduction of immunosuppressants. The evaluation of a patient's cardiovascular function is of paramount importance intraoperatively because major shifts in central blood volume can occur during liver transplantation. The standard cardiac output monitoring technique has been thermodilution using a pulmonary artery catheter (PAC); however, the placement of such may lead to complications. Less invasive innovations utilizing arterial waveform analysis have attracted attentions among the anesthesiologists when it comes to assess a patient's cardiovascular status. What one has to bear in mind is that although the reliability of such devices in measuring cardiac output has been confirmed in many clinical settings, limitations still apply.