Effects of different vasopressors on hemodynamics in patients undergoing orthotopic liver transplantation.

BACKGROUND: The hyperdynamic circulatory state in end-stage liver disease is similar to the hemodynamic state in endotoxic shock. Recent research indicated that proper use of norepinephrine (NE) in patients with endotoxic shock could improve the perfusion of visceral organs and raise the survival rate. In this study, dopamine (DA) or NE combined with DA was infused during the orthotopic liver transplantation (OLT) to observe and compare their effects on hemodynamics, oxygenation, and renal function during different stages of the operation.

METHODS: Thirty American Society of Anesthesiology (ASA) III-IV patients undergoing OLT were randomly divided into group DA and group NE with 15 patients in each group. Vasopressors were infused after induction of anesthesia. DA was infused in group DA; DA and NE in group NE. Data of hemodynamics, oxygenation and renal function were collected after induction, 1 hour in preanhepatic, anhepatic, neohepatic phase and at the end of operation.

RESULTS: Heart rate (HR) and mean arterial pressure (MAP) of the two groups were stable. In anhepatic phase, central venous pressure (CVP), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP), cardiac output (CO), and cardiac index (CI) decreased, whereas systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) increased significantly (P < 0.05). The hemodynamic variables of group NE were more stable than that of group DA. Pulmonary vascular resistance (PVR), pulmonary vascular resistance index (PVRI), power of hydrogen (pH), and mixed venous oxygen saturation (SvO2) had no significant changes. Oxygen delivery (DO2) and oxygen consumption (VO2) decreased during anhepatic phase (P < 0.05), but lactic acid (LAC) increased since anhepatic phase. Blood urea nitrogen (BUN) maintained relatively stable during different phases. Group NE had more urine output (F = 4.733, P = 0.039).

CONCLUSIONS: During OLT, both DA and NE combined with DA can maintain hemodynamics stable, whereas the latter may create better condition. NE has positive effects on maintenance of renal function.