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Vasopressin and nitroglycerin decrease portal and hepatic venous pressure and hepato-splanchnic blood flow

Journal article
Authors Ellinor Wisén
Kristina Svennerholm
Lena Sand Bown
Erik Houltz
Magnus Rizell
Stefan Lundin
Sven-Erik Ricksten
Published in Acta Anaesthesiologica Scandinavica
Volume 62
Issue 7
Pages 953-961
ISSN 0001-5172
Publication year 2018
Published at Institute of Clinical Sciences, Department of Surgery
Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 953-961
Language en
Links dx.doi.org/10.1111/aas.13117
Keywords intermittent pringle maneuver, liver resection, surgery, transplantation, metastases, cirrhosis, survival, lactate, impact, Anesthesiology
Subject categories Surgery

Abstract

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.

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