The use of β-adrenergic drugs improves hepatic oxygen metabolism in cirrhotic patients undergoing liver resection

Background & Aims

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 (4μg/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.

Conclusion

Low doses of vasoactive drugs, especially dobutamine, improved hepatic oxygen supply and uptake preserving immediate function of the remnant cirrhotic liver.

Abbreviations: ROS, reactive oxygen species, BCLC, Barcelona Clinic Liver Cancer classification, MAC, minimal alveolar concentration, CVP, central venous pressure, PCA, patient controlled analgesia, CI, cardiac index, NICO, non-invasive cardiac output, CG, receiving placebo group, DaG, receiving dopamine group, DbG, receiving dobutamine group, PoP, portal vein pressure, HvP, hepatic vein pressure, HaBF, hepatic arterial blood flow, PBF, portal blood flow, THBF, total hepatic blood flow, HaVR, hepatic arterial vascular resistance, PVR, portal vascular resistance, HC, hepatic compliance, HDO₂, hepatic oxygen delivery, HVO₂, hepatic oxygen consumption, HO₂ER, oxygen extraction ratio, HLEx, hepatic lactate extraction ratio, TLH, total lactate presented to the liver, INR, prothrombin time ratio, SVRI, systemic vascular resistance index, HABR, hepatic arterial buffer response, GFR, glomerular filtration renal, HO-1, heme oxygenase-1

Keywords: Hepatic blood flow, β-Adrenergic drugs, Liver cirrhosis, Partial hepatectomy, Hepatic oxygen metabolism