The use of beta-adrenergic drugs improves hepatic oxygen metabolism in cirrhotic patients undergoing liver resection.
OBJECTIVE
Hepatic resection is associated with hemodynamic and oxygen metabolism disturbances of the residual liver resulting from liver regeneration. In underlying liver disease, the remnant liver responds inadequately to increased energy demands leading to a less efficient recovery process. The aim of this study was to assess the effect of vasoactive drugs on hepatic oxygen metabolism and hemodynamics in cirrhotic patients that have undergone liver resection.


METHODS
Thirty patients were randomly allocated to receive peri-operatively low doses (4 microg/kg/min) of dopamine (DaG, n=10), dobutamine (DbG, n=10) or saline (CG, n=10). Hepatic hemodynamics, hepatic oxygen metabolism and lactate uptakes were evaluated before drug administration and at the time of abdominal closure. Post-operative liver function and outcome were recorded.


RESULTS
The peri-operative use of vasoactive drugs preserved total hepatic blood flow and hepatic compliance, even increasing in patients who received Db, whereas those parameters decreased in CG after liver resection. At this time, oxygen delivery and consumption decreased in CG patients, but were unchanged when vasoactive drugs were used. In all groups, lactate uptake decreased sharply and only DbG showed positive lactate extraction capacity. The peak of post-operative bilirubin, which resumed baseline values more quickly in DbG, inversely correlated with intra-operative hepatic compliance and hepatic oxygen extraction.


CONCLUSIONS
Low doses of vasoactive drugs, especially dobutamine, improved hepatic oxygen supply and uptake preserving immediate function of the remnant cirrhotic liver.
Taurà
Pilar
P
Department of Anesthesiology, Liver Surgery and Liver Transplant Unit, Hospital Clinic, Villarroel 170, Barcelona University, Barcelona, Spain. ptaura@clinic.ub.es
Fuster
Josep
J
Mercadal
Jordi
J
Martinez-Palli
Graciela
G
Fondevila
Constantino
C
Blasi
Annabel
A
Balust
Jaume
J
Garcia-Valdecasas
Juan-Carlos
JC
D000318:Adrenergic beta-Agonists / Q000494:pharmacology*; D000368:Aged; D004280:Dobutamine / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology; D004305:Dose-Response Relationship, Drug; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006498:Hepatectomy; D006801:Humans; D007773:Lactates / Q000378:metabolism; D008099:Liver / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D016896:Treatment Outcome
D000318:Adrenergic beta-Agonists; D007773:Lactates; D004280:Dobutamine; D010100:Oxygen; D004298:Dopamine