Enhancing liver blood flow after cardiopulmonary bypass: the effects of dopamine and dopexamine

Perfusion ◽  
1999 ◽  
Vol 14 (1) ◽  
pp. 29-36 ◽  
Author(s):  
D AC Sharpe ◽  
I M Mitchel ◽  
E A Kay ◽  
J P McGoldrick ◽  
C M Munsch ◽  
...  
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Cardiac Index ◽  
Indocyanine Green ◽  
Bypass Graft ◽  
Liver Blood Flow ◽  
Patient Specific ◽  
Disappearance Rate ◽  
Flow Measurements

Liver blood flow is reduced after cardiopulmonary bypass (CPB) and both dopamine and dopexamine are used to overcome this. This study compares the effects of these agents on liver blood flow. Thirty patients undergoing elective coronary artery bypass graft surgery were randomized into three groups ( n = 10 per group). Six hours after surgery baseline liver blood flow was determined by the percentage disappearance rate of indocyanine green measured by dichromatic auricular densitometery. Patients then received infusions of either: (1) placebo (dextrose 5%); (2) dopamine (4 μg/kg/min); (3) dopexamine (1 μg/kg/min increasing to 2 μg/kg/min). One hour after infusion, liver blood flow measurements were repeated. In the dopexamine group the infusion was increased and the measurements repeated another hour later. We found that patient-specific variables and operative details were similar for all groups. Postoperative cardiac index and heart rate were increased significantly by dopamine (cardiac index 2.82 ± 0.46 l/m/m2 vs 3.28 ± 0.67 l/m/m2: p < 0.001 and heart rate 87.5 ± 13.2 vs 96 ± 16: p < 0.05) and dopexamine at 2 μg/kg/min (cardiac index 2.71 ± 0.53 l/m/m2 vs 3.45 ± 0.67 l/m/m2: p < 0.05 and heart rate 89.0 ± 18.9 vs 107.4 ± 13.6: p < 0.001) compared to placebo (cardiac index 2.97 ± 0.8 l/m/m2 vs 3.18 ± 0.9 l/m/m2: p > 0.05 and heart rate 77.2 ± 7.4 vs 77.3 ± 8: p > 0.05) despite similar atrial and systemic arterial pressures. The disappearance rate of indocyanine green was not altered during infusion of placebo group (9.0 ± 3.2%/min vs 7.9 ± 3.0%/min: p > 0.05) or dopexamine at 1 μg/kg/min (9.7 ± 3.1%/min vs 11.2 ± 4.1%/min: p > 0.05). The disappearance rate was increased with dopamine (6.7 ± 3.7%/min vs 11.8 ± 3.0%/min: p < 0.05) and dopexamine 2 μg/kg/min (9.7 ± 3.1%/min vs 13.5 ± 3.2%/min: p < 0.05). This indicates a 76% increase in liver blood flow with dopamine and a 38% increase with dopexamine. We conclude that dopamine 4 μg/kg/min and dopexamine 2 μg/kg/min increase liver blood flow, although this may, in part, be related to an increase in cardiac output. Dopexamine shows no advantage over dopamine in enhancing liver blood flow after CPB.

Liver blood flow during cardiac surgery

Perfusion ◽  
2004 ◽  
Vol 19 (3) ◽  
pp. 153-156 ◽  
Author(s):  
Govind Chetty ◽  
David AC Sharpe ◽  
Jay Nandi ◽  
Stephen J Butler ◽  
Ian M Mitchell
Keyword(s):  
Blood Flow ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Indocyanine Green ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Liver Blood Flow ◽  
Left Ventricular ◽  
Positive Pressure ◽  
Induction Of Anaesthesia

Objective: Impairment of liver blood flow and, therefore, potentially liver function, has important short-term consequences because of the liver’s key metabolic importance and role in drug metabolism. The objective of this study was to quantify the effect of cardiac surgery on liver blood flow from before the induction of anaesthesia to 24 hours postoperatively. Method: Ten patients with no history of liver impairment, moderate or good left ventricular function, and undergoing routine hypothermic coronary artery bypass graft surgery, were entered into the study. Liver blood flow was determined by the clearance of indocyanine green (ICG), expressed as a percentage disappearance rate (PDR). Results: The mean baseline percentage disappearence rate (PDR) of indocyanine green (ICG) was 19.849-4.47%/min. This increased marginally to 20.429-6.67%/min following the induction of anaesthesia, but after 15 min of cardiopulmonary bypass, the PDR fell to 13.519-3.69%/min; this was significantly lower than all other PDRs measured throughout the study. Prior to extubation, the PDR increased again to 20.019-3.72%-min, and this level was maintained at 12 hours (PDR 20.329-3.53%min) and 24 hours (PDR 20.519-2.27%/min). Conclusion: The induction of anaesthesia and positive pressure ventilation do not affect liver blood flow. Cardiopulmonary bypass at 308C is associated with a significant reduction in liver blood flow, which returns to normal within 4 / 6 hours of surgery and remains normal for up to 24 hours after surgery.

Rapid Infusion of Hydroxyethyl Starch 70/0.5 but not Acetate Ringer’s Solution Decreases the Plasma Concentration of Propofol during Target-controlled Infusion

2016 ◽  
Vol 125 (2) ◽  
pp. 304-312 ◽  
Author(s):  
Sayako Itakura ◽  
Kenichi Masui ◽  
Tomiei Kazama
Keyword(s):  
Blood Flow ◽  
Plasma Concentration ◽  
Indocyanine Green ◽  
Blood Volume ◽  
Hydroxyethyl Starch ◽  
Hepatic Blood Flow ◽  
Disappearance Rate ◽  
Rapid Infusion ◽  
Ringer’S Solution ◽  
Target Controlled Infusion

Abstract Background Rapid fluid infusion resulting in increased hepatic blood flow may decrease the propofol plasma concentration (Cp) because propofol is a high hepatic extraction drug. The authors investigated the effects of rapid colloid and crystalloid infusions on the propofol Cp during target-controlled infusion. Methods Thirty-six patients were randomly assigned to 1 of 3 interventions (12 patients per group). At least 30 min after the start of propofol infusion, patients received either a 6% hydroxyethyl starch (HES) solution at 24 ml·kg−1·h−1 or acetated Ringer’s solution at 24 or 2 ml·kg−1·h−1 during the first 20 min. In all groups, acetated Ringer’s solution was infused at 2 ml·kg−1·h−1 during the next 20 min. The propofol Cp was measured every 2.5 min as the primary outcome. Cardiac output, blood volume, and indocyanine green disappearance rate were determined using a pulse dye densitogram analyzer before and after the start of fluid administration. Effective hepatic blood flow was calculated as the blood volume multiplied by the indocyanine green disappearance rate. Results The rapid HES infusion significantly decreased the propofol Cp by 22 to 37%, compared to the Cp at 0 min, whereas the rapid or maintenance infusion of acetate Ringer’s solution did not decrease the propofol Cp. Rapid HES infusion, but not acetate Ringer’s solution infusion, increased the effective hepatic blood flow. Conclusions Rapid HES infusion increased the effective hepatic blood flow, resulting in a decreased propofol Cp during target-controlled infusion. Rapid HES infusion should be used cautiously as it may decrease the depth of anesthesia.

Fluorescent microspheres are superior to radioactive microspheres in chronic blood flow measurements

1998 ◽  
Vol 275 (1) ◽  
pp. H110-H115 ◽  
Author(s):  
Matthijs F. M. Van Oosterhout ◽  
Frits W. Prinzen ◽  
S. Sakurada ◽  
Robb W. Glenny ◽  
J. Robert S. Hales
Keyword(s):  
Blood Flow ◽  
Liver Blood Flow ◽  
Mean Difference ◽  
Radioactive Microspheres ◽  
Fluorescent Microspheres ◽  
Flow Measurements ◽  
Change Over Time ◽  
Radioactive Microsphere ◽  
Blood Flow Measurements ◽  
Over Time

The accuracy of the fluorescent (FM) and radioactive microsphere (RM) techniques is similar in acute experiments but has not been established in chronic experiments. In the present study various combinations (at least pairs) of FM and/or RM labels were injected simultaneously between 2 mo and 5 min before each animal was killed. Blood flow was determined in many organs. Intramethod mean difference and variation did not change over time for FM but increased significantly for RM (from 1.8 ± 1.4 to 25.6 ± 21.8% and from 4.4 ± 3.2 to 32.4 ± 23.0% at 5 min and 2 mo, respectively). Also the FM-RM intermethod mean difference and variation increased (from −0.5 ± 8.5 to 40.8 ± 23.8% and from 23.6 ± 4.6 to 71.8 ± 34.3%, respectively). After 2 mo, blood flow estimations were 20–50% lower with the various RM, whereas brain and liver blood flow values varied even more between isotopes. Underestimation started within 1 day for51Cr and within 2 wk for141Ce,95Nb, and85Sr. We conclude that FM are superior to RM for blood flow determination in experiments lasting longer than 1 day, presumably because of leaching of isotopes from RM.

Direct and indirect measurement of the hepatic extraction ratio of Indocyanine Green in the rat

1989 ◽  
Vol 76 (5) ◽  
pp. 503-508 ◽  
Author(s):  
E. Burns ◽  
C. E. Ball ◽  
J. P. Christie ◽  
G. D. Broadhead ◽  
G. T. Tucker ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Liver Blood Flow ◽  
Compartment Model ◽  
Indirect Measurement ◽  
Extraction Ratio ◽  
Isolated Perfused Rat Liver ◽  
Time Data ◽  
Two Compartment Model ◽  
Liver Preparation

1. In order to estimate liver blood flow in the rat, the extraction ratio of Indocyanine Green was determined using a two-compartment model fitted to the plasma concentration time data after a single intravenous bolus dose and compared with values obtained directly by transhepatic sampling, both in the intact rat and in an isolated perfused rat liver preparation. 2. There was no agreement between estimates of the extraction ratio obtained by using the kinetic model and the directly measured values. 3. Elimination curves for Indocyanine Green were simulated to yield varied clearance values. Despite a 250% variation in clearance, extraction ratios derived using the two-compartment model were all greater than 0.9 and varied by less than 6%. 4. Estimates of liver blood flow obtained by deriving a value of the extraction ratio of Indocyanine Green using the two-compartment model are inaccurate.

The effect of normothermic cardiopulmonary bypass on hepatic blood flow in the dog

Perfusion ◽  
1986 ◽  
Vol 1 (4) ◽  
pp. 245-253 ◽  
Author(s):  
RT Mathie ◽  
JB Desai ◽  
KM Taylor
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Vascular Resistance ◽  
Flow Rate ◽  
Hepatic Blood Flow ◽  
Liver Blood Flow ◽  
Relative Reduction ◽  
Blood Flows ◽  
Pump Flow ◽  
Pump Flow Rate

Hepatic blood flow was investigated in two groups of eight anaesthetized dogs during and after one hour of either pulsatile or non-pulsatile cardiopulmonary bypass (CPB). Mean perfusion pressure was maintained at 60 mmHg. Hepatic arterial (HA) and portal venous (PV) blood flows were measured using electromagnetic flow probes, and hepatic O 2 consumption determined. The results demonstrate that: (a) pulsatile CPB reduces peripheral vascular resistance during and after perfusion, and more effectively preserves pump flow rate and cardiac output than non-pulsatile CPB; (b) total liver blood flow is sustained more effectively by pulsatile CPB than by non-pulsatile CPB due to relative preservation of both HA and PV flows; (c) hepatic O2 consumption is only marginally better preserved during and after pulsatile CPB than with non-pulsatile perfusion. We conclude that: (a) pulsatile CPB tends to maintain hepatic blood flow through a relative reduction in HA vascular resistance and an improvement in PV flow produced passively by a greater pump flow rate; (b) pulsatile CPB less effectively benefits hepatic O2 consumption because of poor O2 uptake from the hepatic PV blood supply.

Higher Hematocrit Improves Liver Blood Flow and Metabolism During Cardiopulmonary Bypass in Piglets

2001 ◽  
Vol 49 (04) ◽  
pp. 226-230 ◽  
Author(s):  
G. Nollert ◽  
J. Sperling ◽  
T. Sakamoto ◽  
B. Jaeger ◽  
R. Jonas
Keyword(s):  
Blood Flow ◽  
Cardiopulmonary Bypass ◽  
Liver Blood Flow

Influence of 1-Desamino-8-d-Vasopressin on Endogenous Fibrinolysis, Haemodynamics and Liver Blood Flow in Healthy Subjects

1994 ◽  
Vol 86 (5) ◽  
pp. 497-503 ◽  
Author(s):  
J. Burggraaf ◽  
H. C. Schoemaker ◽  
J. M. Kroon ◽  
L. Huisman ◽  
C. Kluft ◽  
...  
Keyword(s):  
Blood Flow ◽  
Confidence Interval ◽  
Indocyanine Green ◽  
Plasminogen Activator ◽  
Liver Blood Flow ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Plasminogen Activator Activity ◽  
Type Plasminogen Activator ◽  
Fibrinolytic Parameters

1. Endogenous fibrinolytic capacity increases after administration of 1-desamino-8-d-vasopressin. This increase is commonly attributed to an increase in release of tissue-type plasminogen activator from the endothelium. However, the possibility that 1-desamino-8-d-vasopressin influences liver blood flow, which is a major determinant of tissue-type plasminogen activator clearance, cannot be ruled out. 2. The influence of 1-desamino-8-d-vasopressin on haemodynamics, liver blood flow and fibrinolytic parameters was investigated in a randomized double-blind cross-over study in nine healthy male subjects (age 20–26 years). 3. 1-Desamino-8-d-vasopressin exerted significant haemodynamic effects: mean arterial pressure decreased maximally 12 (95% confidence interval 8–15) mmHg and heart rate increased maximally 21 (95% confidence interval 15–27) beats/min. 4. Endogenous fibrinolytic parameters increased after administration of 1-desamino-8-d-vasopressin. Both tissue-type plasminogen activator antigen and tissue-type plasminogen activator activity were elevated and showed the maximal response shortly after drug administration was completed. 5. 1-Desamino-8-d-vasopressin increased portal venous blood flow as measured with echo-Doppler. The maximal increase in mean blood flow of 55 (95% confidence interval 19–92)% was observed at the end of the 1-desamino-8-d-vasopressin infusion and coincided with the maximal changes in systemic haemodynamics and fibrinolytic parameters. The increase in portal blood flow was not reflected in significant changes in Indocyanine Green clearance. It appears that the Indocyanine Green method is relatively insensitive to increases in liver blood flow. 6. The observed increase in fibrinolytic activity due to tissue-type plasminogen activator activity after 1-desamino-8-d-vasopressin administration may be due to an increased release of tissue-type plasminogen activator from the endothelium and is not caused by changes in clearance.

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