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

General Anesthesia Clinical Trial

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

Clinical Trial 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.

Clinical Trial 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 ;

Study Design

Related Conditions & MeSH terms

Clinical Trial Details
NCT number NCT04893655
Study type Interventional
Source University Hospital, Ghent
Contact
Status Completed
Phase Phase 4
Start date September 14, 2021
Completion date July 25, 2023
View Details
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