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The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study.

Ibrahim N, Hasanin A, Allah SA, Sayed E, Afifi M, Yassen K, Saber W, Khalil M - Indian J Anaesth (2015)

Bottom Line: Urea, creatinine and UOP were significantly better with terlipressin.Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion.Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.

ABSTRACT

Background and aims: Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters.

Methods: After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index <2600 dyne.s/cm5(/) m2 till day 4. Nor-epinephrine was used as appropriate. Haemodynamic and transoesophageal Doppler parameters (intraoperative), renal function, peak portal vein blood flow velocity (PPV), hepatic artery resistive index (HARI), urine output (UOP), liver enzymes, catecholamine support were compared intra-operatively and 4 days post-operatively. Desflurane administration was guided with entropy.

Results: Terlipressin maintained better MAP and SVR (P < 0.01) during reperfusion versus controls (66.5 ± 16.08 vs. 47.7 ± 4.7 mmHg and 687.7 ± 189.7 vs. 425.0 ± 26.0 dyn.s/cm(5)), respectively. Nor epinephrine was used in 5 out of 25 versus 20 in controls. Urea, creatinine and UOP were significantly better with terlipressin. PPV was reduced with terlipressin post-reperfusion versus controls (44.8 ± 5.2 vs. 53.8 ± 3.9 ml/s, respectively, P < 0.01) without affecting HARI (0.63 ± 0.06 vs. 0.64 ± 0.05, respectively, P > 0.05) and was sustained post-operatively.

Conclusion: Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

No MeSH data available.


Related in: MedlinePlus

Urine output mean ± standard deviation differences between terlipressin group (T) and control group (C), tested by paired t-test, *indicates P < 0.05 statistically significant. Day 0: During day of operation. Days 1, 2, 3, and 4: post-operative days 1, 2, 3 and 4
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Figure 3: Urine output mean ± standard deviation differences between terlipressin group (T) and control group (C), tested by paired t-test, *indicates P < 0.05 statistically significant. Day 0: During day of operation. Days 1, 2, 3, and 4: post-operative days 1, 2, 3 and 4

Mentions: Heart rate, COP, CVP and FTc were comparable between two groups at different intervals [Table 2]. No significant difference were observed between T and C groups concerning intraoperative colloids infusion (hydroxyethyl starch), (2500 ± 500 vs. 2520 ± 489.04 ml, respectively, P = 0.887). No major haemodynamic incidents were seen peri-operatively. The use of packed red blood cells and fresh-frozen plasma were comparable between the two groups (4 [0–5.5] and 3 [0–5.5] units in terlipressin group vs. 4 [0–4] and 4 [2.25–6.75] units, in control group). There was a significant decrease in urea and creatinine blood levels associated with an improvement in UOP with terlipressin compared with controls (P < 0.01) [Table 3], [Figure 3]. PVBF after reperfusion decreased significantly in the T group compared with controls (44.85 ± 5.22 vs. 54.3 ± 3 ml/s, respectively, P > 0.01) and this change was sustained at all-time points measured, but with no significant differences between both groups regarding the hepatic artery blood flow reflected in the HARI [Table 4].


The haemodynamic effects of the perioperative terlipressin infusion in living donor liver transplantation: A randomised controlled study.

Ibrahim N, Hasanin A, Allah SA, Sayed E, Afifi M, Yassen K, Saber W, Khalil M - Indian J Anaesth (2015)

Urine output mean ± standard deviation differences between terlipressin group (T) and control group (C), tested by paired t-test, *indicates P < 0.05 statistically significant. Day 0: During day of operation. Days 1, 2, 3, and 4: post-operative days 1, 2, 3 and 4
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4378076&req=5

Figure 3: Urine output mean ± standard deviation differences between terlipressin group (T) and control group (C), tested by paired t-test, *indicates P < 0.05 statistically significant. Day 0: During day of operation. Days 1, 2, 3, and 4: post-operative days 1, 2, 3 and 4
Mentions: Heart rate, COP, CVP and FTc were comparable between two groups at different intervals [Table 2]. No significant difference were observed between T and C groups concerning intraoperative colloids infusion (hydroxyethyl starch), (2500 ± 500 vs. 2520 ± 489.04 ml, respectively, P = 0.887). No major haemodynamic incidents were seen peri-operatively. The use of packed red blood cells and fresh-frozen plasma were comparable between the two groups (4 [0–5.5] and 3 [0–5.5] units in terlipressin group vs. 4 [0–4] and 4 [2.25–6.75] units, in control group). There was a significant decrease in urea and creatinine blood levels associated with an improvement in UOP with terlipressin compared with controls (P < 0.01) [Table 3], [Figure 3]. PVBF after reperfusion decreased significantly in the T group compared with controls (44.85 ± 5.22 vs. 54.3 ± 3 ml/s, respectively, P > 0.01) and this change was sustained at all-time points measured, but with no significant differences between both groups regarding the hepatic artery blood flow reflected in the HARI [Table 4].

Bottom Line: Urea, creatinine and UOP were significantly better with terlipressin.Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion.Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia, Liver Institute, Menoufiya University, Menufiya, Egypt.

ABSTRACT

Background and aims: Liver disease is usually accompanied with a decline in systemic vascular resistance (SVR). We decided to assess effects of the peri-operative terlipressin infusion on liver donor liver transplantation recipients with respect to haemodynamics and renal parameters.

Methods: After Ethical Committee approval for this prospective randomised controlled study, 50 recipients were enrolled and allotted to control (n = 25) or terlipressin group (n = 25) with simple randomisation method. Terlipressin was infused at 1.0 μg/kg/h and later titrated 1.0-4.0 μg/kg/h to maintain mean arterial pressure (MAP) >65 mmHg and SVR index <2600 dyne.s/cm5(/) m2 till day 4. Nor-epinephrine was used as appropriate. Haemodynamic and transoesophageal Doppler parameters (intraoperative), renal function, peak portal vein blood flow velocity (PPV), hepatic artery resistive index (HARI), urine output (UOP), liver enzymes, catecholamine support were compared intra-operatively and 4 days post-operatively. Desflurane administration was guided with entropy.

Results: Terlipressin maintained better MAP and SVR (P < 0.01) during reperfusion versus controls (66.5 ± 16.08 vs. 47.7 ± 4.7 mmHg and 687.7 ± 189.7 vs. 425.0 ± 26.0 dyn.s/cm(5)), respectively. Nor epinephrine was used in 5 out of 25 versus 20 in controls. Urea, creatinine and UOP were significantly better with terlipressin. PPV was reduced with terlipressin post-reperfusion versus controls (44.8 ± 5.2 vs. 53.8 ± 3.9 ml/s, respectively, P < 0.01) without affecting HARI (0.63 ± 0.06 vs. 0.64 ± 0.05, respectively, P > 0.05) and was sustained post-operatively.

Conclusion: Terlipressin improved SVR and MAP with less need for catecholamines particularly post-reperfusion. Terlipressin reduced PPV without hepatic artery vasoconstriction and improved post-operative UOP.

No MeSH data available.


Related in: MedlinePlus