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Vasopressin and nitroglycerin decrease portal and hepatic venous pressure and hepato-splanchnic blood flow
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- Wisén, Ellinor, 1978 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
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- Svennerholm, Kristina, 1981 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
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- Sand Bown, Lena (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för anestesiologi och intensivvård,Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
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- 2018-03-26
- 2018
- English.
- In: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 62:7, s. 953-961
- Journal article (peer-reviewed)
Abstract
Subject headings
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- BackgroundVarious methods are used to reduce venous blood pressure in the hepato-splanchnic circulation, and hence minimise blood loss during liver surgery. Previous studies show that combination of vasopressin and nitroglycerin reduces portal pressure and flow in patients with portal hypertension, and in this study we investigated this combination in patients with normal portal pressure. MethodIn all, 13 patients were studied. Measurements were made twice to confirm baseline (C1 and BL), during vasopressin infusion 4.8 U/h (V), and during vasopressin infusion combined with nitroglycerin infusion (V + N). Portal venous pressure (PVP), hepatic venous pressure (HVP), central haemodynamics and arterial and venous blood gases were obtained at each measuring point, and portal (splanchnic) and hepato-splanchnic blood flow changes were calculated. ResultsVasopressin alone did not affect PVP, whereas HVP increased slightly. In combination with nitroglycerin, PVP decreased from 10.1 1.6 to 8.9 +/- 1.3 mmHg (P < 0.0001), and HVP decreased from 7.9 +/- 1.9 to 6.2 +/- 1.3 mmHg (P = 0.001). Vasopressin reduced portal blood flow by 47 +/- 19% and hepatic venous flow by 11 +/- 18%, respectively. Addition of nitroglycerin further reduced portal- and hepatic flow by 55 +/- 13% and 30 +/- 13%, respectively. Vasopressin alone had minor effects on central haemodynamics, whereas addition of nitroglycerin reduced cardiac index (3.2 +/- 0.7 to 2.7 +/- 0.5; P < 0.0001). The arterial-portal vein lactate gradient was unaffected. ConclusionThe combination of vasopressin and nitroglycerin decreases portal pressure and hepato-splanchnic blood flow, and could be a potential treatment to reduce bleeding in liver resection surgery.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- intermittent pringle maneuver
- liver resection
- surgery
- transplantation
- metastases
- cirrhosis
- survival
- lactate
- impact
- Anesthesiology
Publication and Content Type
- ref (subject category)
- art (subject category)
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