title: A comparison of intra-operative blood loss and acid-base balance between vasopressor and inotrope strategy during living donor liver transplantation: a randomised, controlled study.
abstract: Administration of vasopressors or inotropes during liver transplant surgery is almost universal, as this procedure is often accompanied by massive haemorrhage, acid-base imbalance, and cardiovascular instability. However, the actual agents that should be used and the choice between a vasopressor and an inotrope strategy are not clear from existing published evidence. In this prospective, randomised, controlled and single-blinded study, we compared the effects of a vasopressor strategy on intra-operative blood loss and acid-base status with those of an inotrope strategy during living donor liver transplantation. Seventy-six adult liver recipients with decompensated cirrhosis were randomly assigned to receive a continuous infusion of either phenylephrine at a dose of 0.3-0.4 μg.kg(-1).min(-1) or dopamine and/or dobutamine at 2-8 μg.kg(-1).min(-1) during surgery. Vascular resistance was higher over time in the phenylephrine group than in the dopamine/dobutamine group. Estimated blood loss was significantly lower in the phenylephrine group than in the dopamine/dobutamine group (mean (SD) 4.5 (1.8) l vs 6.1 (3.4) l, respectively, p=0.011). Patients in the phenylephrine group had lower lactate levels in the late pre-anhepatic and the early anhepatic phase and needed less bicarbonate administration than those in the dopamine/dobutamine group (median (IQR [range]) 40 (0-100 [0-160]) mEq vs 70 (40-163 [0-260]) mEq, respectively, p=0.018). Postoperative clinical outcomes and laboratory-measured hepatic and renal function did not differ between the groups. Increased vascular resistance and reduction of portal blood flow by intra-operative phenylephrine infusion is assumed to decrease the amount of intra-operative bleeding and thereby ameliorate the progression of lactic acidosis during liver transplant surgery.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul St. Mary's Hospital, Seoul, Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Hong
authors.forename: C S
authors.initials: CS
authors.lastname: Park
authors.forename: H S
authors.initials: HS
authors.lastname: Jung
authors.forename: H
authors.initials: H
authors.lastname: Choi
authors.forename: S R
authors.initials: SR
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Lee
authors.forename: J H
authors.initials: JH
authors.lastname: Choi
mesh_terms: D000136:Acid-Base Equilibrium / Q000502:physiology*; D000758:Anesthesia; D016063:Blood Loss, Surgical / Q000517:prevention & control* / Q000706:statistics & numerical data*; D002316:Cardiotonic Agents / Q000494:pharmacology*; D004280:Dobutamine / Q000494:pharmacology; D004298:Dopamine / Q000494:pharmacology; D005260:Female; D006400:Hematocrit; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010656:Phenylephrine / Q000494:pharmacology; D011446:Prospective Studies; D013916:Thrombelastography; D014563:Urodynamics / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000494:pharmacology*
chemical_list: D002316:Cardiotonic Agents; D014662:Vasoconstrictor Agents; D010656:Phenylephrine; D019344:Lactic Acid; D004280:Dobutamine; D004298:Dopamine