Low-dose dopexamine in patients undergoing hemihepatectomy: an evaluation of effects on reduction of hepatic dysfunction and ischaemic liver injury.
BACKGROUND
Hepatic dysfunction is a common problem in patients after hemihepatectomy. Treatment with low-dose dopamine has been shown to be beneficial in hemihepatectomy patients. We hypothesized that dopexamine, a synthetic vasoactive catecholamine, due to its specific pharmocodynamic profile may be more effective in reducing hidden ischaemic episodes in the hepato-splanchnic region during and after temporary total cross-clamping of hepatic inflow in these patients.


METHODS
The effects of low-dose dopexamine on hepatic venous haemoglobin oxygen saturation (ShvO2), hepatic venous lactate level, monoethylglycinxylid (MEGX) formation, hepatic synthetic function and indicators for hepatic cell damage were studied during hemihepatectomy and for 16 h postoperatively in hemihepatectomy patients and compared to those of low-dose dopamine. In a prospective, double-blind clinical study 20 patients received randomly either dopexamine (DPX) 0.5 microg kg(-1) min(-1) (n=10) or dopamine (DO) 2.5 microg kg(-1) min(-1) (n= 10). Infusions were started after induction of anaesthesia and continued 16 h postoperatively. Hepatic vein, radial and pulmonary artery were catheterized. Measurements were carried out after induction of anaesthesia, after total cross-clamping of hepatic inflow, and at 2 h and 16 h postoperatively.


RESULTS
There were no differences in systemic haemodynamics, oxygenation, ShvO2, serum aminotransferases or MEGX levels between the groups. At 16 h postoperatively prothrombin and antithrombin III levels were significantly lower while hepatic venous lactate was significantly higher in the DPX group compared to the DO group.


CONCLUSIONS
In patients undergoing hemihepatectomy, we could not reveal superior hepatoprotective effects of low-dose dopexamine compared to low-dose dopamine.
Marx
G
G
Department of Anaesthesiology, Hannover Medical School, Germany. marx.gernot@mh-hannover.de
Leuwer
M
M
Höltje
M
M
Bornscheuer
A
A
Herrmann
H
H
Mahr
K H
KH
Vangerow
B
B
Heine
J
J
Piepenbrock
S
S
Rueckoldt
H
H
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D004298:Dopamine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018491:Dopamine Agonists / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006498:Hepatectomy; D006503:Hepatic Veins; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008012:Lidocaine / Q000031:analogs & derivatives / Q000032:analysis; D008099:Liver / Q000378:metabolism*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010108:Oxyhemoglobins / Q000032:analysis; D011446:Prospective Studies; D011516:Prothrombin / Q000032:analysis; D015427:Reperfusion Injury / Q000503:physiopathology / Q000517:prevention & control*; D000637:Transaminases / Q000097:blood; D014665:Vasodilator Agents / Q000008:administration & dosage*
D018491:Dopamine Agonists; D010108:Oxyhemoglobins; D014665:Vasodilator Agents; D019344:Lactic Acid; C046318:dopexamine; D000990:Antithrombin III; D011516:Prothrombin; D008012:Lidocaine; C001173:monoethylglycinexylidide; D000637:Transaminases; D010100:Oxygen; D004298:Dopamine