{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:12:14Z","timestamp":1791972734361,"version":"4.3.4"},"reference-count":58,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T00:00:00Z","timestamp":1670544000000},"content-version":"vor","delay-in-days":69,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Liver transplant centers vary in approach to intraoperative vascular accesses, monitoring of cardiac function and temperature management. Evidence is limited regarding impact of selected modalities on postoperative outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To review the literature and provide expert panel recommendations on optimal intraoperative arterial blood pressure (BP), central venous pressure (CVP), and vascular accesses, monitoring of cardiac function and intraoperative temperature management regarding immediate and short\u2010term outcomes after orthotopic liver transplant (OLT).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Recommendations made for: (1) Vascular accesses, arterial BP and CVP monitoring, (2) cardiac function monitoring, and (3) Intraoperative temperature management (CRD42021239908).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 2619 articles screened 16 were included. Studies were small, retrospective, and observational. Vascular access studies demonstrated low rates of insertion complications. TEE studies demonstrated low rates of esophageal hemorrhage. One study found lower hospital\u2010LOS and 30\u2010day mortality in patients monitored with both PAC and TEE. Other monitoring studies were heterogenous in design and outcomes. Temperature studies showed increased blood transfusion and ventilation times in hypothermic groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Recommendations were made for; routine arterial and CVP monitoring as a minimum standard of practice, consideration of discrepancy between peripheral and central arterial BP in patients with hemodynamic instability and high vasopressor requirements, and routine use of high flow cannulae while monitoring for extravasation and hematoma formation. Availability and expertise in PAC and\/or TEE monitoring is strongly recommended particularly in hemodynamic instability, portopulmonary HT and\/or cardiac dysfunction. TEE use is recommended as an acceptable risk in patients with treated esophageal varices and is an effective diagnostic tool for emergency cardiovascular collapse. Maintenance of intraoperative normothermia is strongly recommended.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14643","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T16:15:05Z","timestamp":1646842505000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["What is the optimal anesthetic monitoring regarding immediate and short\u2010term outcomes after liver transplantation?\u2014A systematic review of the literature and expert panel recommendations"],"prefix":"10.1111","volume":"36","author":[{"given":"Thomas M.A.","family":"Fernandez","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Perioperative Medicine Auckland City Hospital  Auckland New Zealand"},{"name":"Department of Anesthesia University of Auckland  Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Schofield","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus G","family":"Krenn","sequence":"additional","affiliation":[{"name":"Department of Anesthesia Intensive Care Medicine and Pain Medicine Medical University of Vienna  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Rizkalla","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Spiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care Medicine Royal Free Hospital  London UK"},{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitri Aristotle","family":"Raptis","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"},{"name":"Division of Surgery &amp; 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