Fenoldopam and gastric tonometry during orthotopic liver transplantation.
The aim of this study was to evaluate the effects of continuous infusion of fenoldopam on splanchnic perfusion in orthotopic liver transplant (OLT) recipients.


METHODS
We enrolled 40 patients of mean age 57+/-16 years who underwent (OLT). They were randomly divided into two double blinded groups; continuous fenoldopam (0.06 mcg/kg per minute) or placebo infusion. Hemodynamics, gastric tonometry, urine output, renal function parameters, and diuretics use were collected during selected phases of the surgery and postoperatively every 12 hours for 72 hours in the intensive care unit.


RESULTS
No significant differences were observed between the two groups concerning hemodynamics, though in the fenoldopam group we observed increased splanchnic perfusion during the whole study period but particularly after arterial unclamping (pHi 7,31+/-0.04 vs 7.28+/-0.05; P < .05) and at 48 hours after surgery (pHi 7.49+/-0.15 vs 7.39+/-0.15; P < .05). Creatinine and blood urea nitrogen values were slightly higher in the placebo group, but this data did not reach statistical significance, while higher doses of furosemide were administered to the placebo group to maintain a urinary output over 200 mL/hour during the whole study.


CONCLUSIONS
In this study we observed that continuous fenoldopam infusion (0.06 mg/kg per minute) improved splanchnic perfusion without affecting systemic pressure.


CONCLUSIONS
Patients undergoing OLT have altered splanchnic perfusion related to cirrhosis, surgical manipulation, and fluid shifts during and after surgery. The use of a splanchnic vasodilator drug improved outcomes in these patients.
Pugliese
F
F
Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Università dedegli studi di Roma La Sapienza Universita' Degli Studi di Roma La Sapienza, Roma, Italy. mavif@tiscali.it
Ruberto
F
F
Bruno
K
K
Martelli
S
S
Perrella
S
S
Cappannoli
A
A
D'Alio
A
A
Messina
T
T
Summonti
D
D
Pietropaoli
C
C
Rossi
M
M
Novelli
G
G
Berloco
P B
PB
Pietropaoli
P
P
D000328:Adult; D000368:Aged; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D018818:Fenoldopam / Q000008:administration & dosage / Q000627:therapeutic use*; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007262:Infusions, Intravenous; D007431:Intraoperative Complications / Q000517:prevention & control; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010919:Placebos
D018491:Dopamine Agonists; D010919:Placebos; D018818:Fenoldopam