Effect of Dobutamine on Hepatic Blood Flow During Goal-directed Hemodynamic Therapy

  • STATUS
    Recruiting
  • participants needed
    28
  • sponsor
    University Hospital, Ghent
Updated on 29 January 2023

Summary

Maintaining adequate perfusion pressure and oxygen supply is essential for organ survival. Splanchnic hypoperfusion during the perioperative period in abdominal surgery may result in mucosal ischemia with increased permeability of the gut barrier. Additionally, the liver is also sensitive for hypoxemia and hypoperfusion, especially during liver surgery.

Anesthetics (such as propofol or sevoflurane) have a cardiovascular depressant effect, resulting in a reduction of cardiac output (CO). Dobutamine is used to counteract myocardial depressant effect of anesthetics. Additionally, dobutamine is frequently used during abdominal surgery to maintain splanchnic perfusion.

Dobutamine could increase hepatic blood flow (HBF) indirectly by increasing cardiac output or directly by stimulating adrenergic receptors in the splanchnic circulation. The hepatic circulation has a large number of alpha and beta adrenergic receptors and could be sensitive for adrenergic stimulation such as dobutamine. Hence, dobutamine could have a direct effect on the hepatic vasculature.

The aim of the study is to evaluate the effect of dobutamine on hepatic blood flow during goal directed hemodynamic therapy and to distinguish between potential direct and indirect effects.

Description

All patients receive standardized anesthesia care for pancreaticoduodenectomy according to the existing departmental protocol for these interventions.

All patients receive individualized goal-directed hemodynamic therapy based on the transpulmonary thermodilution technique.

At designated times, hemodynamic variables will be recorded. These include :

  • Heart rate (bpm)
  • Central venous pressure (mmHg)
  • Systolic arterial pressure (mmHg)
  • Diastolic arterial pressure (mmHg)
  • Mean arterial pressure (mmHg)
  • Cardiac index (L/min/m2)
  • Pulse pressure variation (PPV)
  • Stroke volume variation (SVV)

Measurements of hepatic flow and pressure will be performed by the surgeon :

  • Hepatic flow : in the hepatic artery (arterial HBF) and portal vein (portal HBF).
  • Pressure measurements : in portal vein (PPorta) and caval vein (PCava)

Measurements will be done :

  • without inotropic support
  • with infusion of dobutamine 2mcg/kg/min
  • with infusion of dobutamine 5mcg/kg/min

Details
Condition general anaesthetic, general anaesthesia, General Anesthesia
Treatment Dobutamine Hydrochloride
Clinical Study IdentifierNCT04893655
SponsorUniversity Hospital, Ghent
Last Modified on29 January 2023

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