The effects of vasoactive drugs on hepatic blood flow changes induced by CO2 laparoscopy: an animal study.
Laparoscopic surgery is associated with systemic and splanchnic hemodynamic alterations. Recent data suggest that small-dose dobutamine may attenuate the reduction in splanchnic blood flow associated with increments in intraabdominal pressure. We conducted this study to analyze the effects of dopamine and dobutamine on the hepatic circulation in this setting. Twenty-one pigs were anesthetized and mechanically ventilated. A flow-directed pulmonary artery and carotid artery catheters were inserted. Perivascular flow probes were placed around the main hepatic artery and the portal vein. CO2 was insufflated into the peritoneal cavity to reach an intraabdominal pressure of 15 mm Hg. After 60 min, animals received dopamine (5 microg x kg(-1) x min(-1); n = 8), dobutamine (5 microg x kg(-1) x min(-1); n = 8), or saline (n = 5) for 30 min. Pneumoperitoneum induced significant increases in heart rate, mean arterial pressure, and systemic vascular resistance, with decreases in cardiac output and hepatic artery and portal vein blood flows. Dobutamine infusion, in contrast to dopamine, corrected, at least in part, cardiac output, systemic vascular resistance, and hepatic artery blood flow alterations, but neither drug restored total hepatic blood flow.


CONCLUSIONS
Hepatic blood flow decreases during laparoscopic surgery. A small-dose infusion of neither dobutamine nor dopamine corrects the total hepatic blood flow impairment, but the former is able to restore the hepatic arterial blood supply in an animal model mimicking this condition.
Agustí
M
M
Department of Anesthesia (URSC), Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
Elizalde
J I
JI
Adàlia
R
R
Martínez-Pallí
G
G
García-Valdecasas
J C
JC
Piqué
J M
JM
Taurà
P
P
D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000818:Animals; D016280:Atrial Function, Right / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002245:Carbon Dioxide / Q000008:administration & dosage / Q000009:adverse effects; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D004280:Dobutamine / Q000494:pharmacology*; D004298:Dopamine / Q000494:pharmacology*; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006499:Hepatic Artery / Q000187:drug effects / Q000502:physiology; D006503:Hepatic Veins / Q000187:drug effects / Q000502:physiology; D007327:Insufflation; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008102:Liver Circulation / Q000187:drug effects* / Q000502:physiology; D008297:Male; D013552:Swine
D000318:Adrenergic beta-Agonists; D002245:Carbon Dioxide; D004280:Dobutamine; D004298:Dopamine