title: Vasopressin-induced changes in splanchnic blood flow and hepatic and portal venous pressures in liver resection.
abstract: BACKGROUND
  To minimize blood loss during hepatic surgery, various methods are used to reduce pressure and flow within the hepato-splanchnic circulation. In this study, the effect of low- to moderate doses of vasopressin, a potent splanchnic vasoconstrictor, on changes in portal and hepatic venous pressures and splanchnic and hepato-splanchnic blood flows were assessed in elective liver resection surgery.
  
  
  METHODS
  Twelve patients were studied. Cardiac output (CO), stroke volume (SV), mean arterial (MAP), central venous (CVP), portal venous (PVP) and hepatic venous pressures (HVP) were measured, intraoperatively, at baseline and during vasopressin infusion at two infusion rates (2.4 and 4.8 U/h). From arterial and venous blood gases, the portal (splanchnic) and hepato-splanchnic blood flow changes were calculated, using Fick's equation.
  
  
  RESULTS
  CO, SV, MAP and CVP increased slightly, but significantly, while systemic vascular resistance and heart rate remained unchanged at the highest infusion rate of vasopressin. PVP was not affected by vasopressin, while HVP increased slightly. Vasopressin infusion at 2.4 and 4.8 U/h reduced portal blood flow (-26% and -37%, respectively) and to a lesser extent hepato-splanchnic blood flow (-9% and -14%, respectively). The arterial-portal vein lactate gradient was not significantly affected by vasopressin. Postoperative serum creatinine was not affected by vasopressin.
  
  
  CONCLUSIONS
  Short-term low to moderate infusion rates of vasopressin induced a splanchnic vasoconstriction without metabolic signs of splanchnic hypoperfusion or subsequent renal impairment. Vasopressin caused a centralization of blood volume and increased cardiac output. Vasopressin does not lower portal or hepatic venous pressures in this clinical setting.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: L Sand
authors.initials: LS
authors.lastname: Bown
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: S-E
authors.initials: SE
authors.lastname: Ricksten
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Houltz
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Landspitali University Hospital, Reykjavik, Iceland.
authors.forename: H
authors.initials: H
authors.lastname: Einarsson
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Söndergaard
authors.affiliation: Department of Transplantation and Liver Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Rizell
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Lundin
mesh_terms: D000368:Aged; D000758:Anesthesia; D001784:Blood Gas Analysis; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001794:Blood Pressure / Q000187:drug effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008099:Liver / Q000601:surgery*; D008102:Liver Circulation / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000187:drug effects*; D013152:Splanchnic Circulation / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000494:pharmacology*; D014667:Vasopressins / Q000494:pharmacology*
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins