Effects of dopamine alone or dopamine plus norepinephrine on hemodynamics, tissue oxygenation and renal function during orthotopic liver transplantation / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effects of dopamine (DA) alone or DA plus norepinephrine (NE) on hemodynamics, tissue oxygenation, acid-base balance and renal function during orthotopic liver transplantation (OLT).Methods Thirty ASA IE or IV patients undergoing OLT were randomly divided into 2 groups of 15 patients each. In group A DA was continuously infused during operation. The initial infusion rate was 1-3 ?g?kg-1 ?min-1 . The rate was then adjusted to MAP between 60-80 mmHg. While in group B DA and NE were continuously infused. The initial infusion rate of DA was 1-3 (?g?kg-1?min-1 and that of NE 0.03 ?g?kg-1?min-1 . Both rates were adjusted to MAP between 60-80 mm Hg but the maximal DA infusion rate was 5 ?g?kg-1?min-1 . Anesthesia was induced with midazolam, propofol, fentanyl and vecuronium and maintained with isoflurane inhalation, continuous propofol infusion and intermittent i.v. boluses of fentanyl, midazolam and pipecuronium. Radial artery was cannulated and S-G catheter was placed via right internal jugular vein. Hemodynamic variables such as MAP, CVP, PAP, PCWP, SVRI, PVRI, blood gases, mixed venous blood O2 saturation (SvO2), blood lactate, Cr and BUN were measured and O2 delivery (DO2 ) and O2 consumption (VO2 ) were calculated and recorded after induction and before surgery (T1 baseline), 60 min after operation was started (T2), at 60 min anhepatic phase (T3) and 60 min neohepatic phase (T4 ) and at the end of operation ( T5). Results There were no significant differences between the two groups with respect to age, sex, body weight, duration of operation and types of surgery. MAP and HR were quite stable in both groups. CVP, MPAP, PCWP, cardiac output (CO) and CI were significantly decreased while SVR and SVRI were increased during anhepatic phase (T3 ) in both groups ( P