Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study
Abstract Background Norepinephrine (NE) is a α1-adrenergic mediated vasopressor and a key player in the treatment of perioperative hypotension. Apart from modulating systemic hemodynamics, NE may also affect regional blood flow, such as the hepatic circulation, which contains a wide variety of adren...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-022-01741-2 |
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| author | Jurgen van Limmen Xavier Iturriagagoitia Marilie Verougstraete Piet Wyffels Frederik Berrevoet Luís Filipe Abreu de Carvalho Stefan De Hert Luc De Baerdemaeker |
| author_facet | Jurgen van Limmen Xavier Iturriagagoitia Marilie Verougstraete Piet Wyffels Frederik Berrevoet Luís Filipe Abreu de Carvalho Stefan De Hert Luc De Baerdemaeker |
| author_sort | Jurgen van Limmen |
| collection | DOAJ |
| description | Abstract Background Norepinephrine (NE) is a α1-adrenergic mediated vasopressor and a key player in the treatment of perioperative hypotension. Apart from modulating systemic hemodynamics, NE may also affect regional blood flow, such as the hepatic circulation, which contains a wide variety of adrenergic receptors. It may alter regional vascular tonus and hepatic blood flow (HBF) by reducing portal vein flow (PVF) or hepatic arterial flow (HAF). The aim of this study was to assess the effects of NE on HBF. Methods Patients scheduled for pancreaticoduodenectomy were included. All patients received standardized anesthetic care using propofol and remifentanil and were hemodynamically stabilized using a goal-directed hemodynamic strategy guided by Pulsioflex™. On surgical indication, somatostatin (SOMATO) was given to reduce pancreatic secretion. HBF measurements were performed using transit-time ultrasound (Medistim™). Baseline hemodynamic and HBF measurements were made after pancreatectomy, at T1. Afterwards, NE infusion was initiated to increase mean arterial pressure (MAP) by 10 – 20% of baseline MAP (T2) and by 20 – 30% of baseline MAP (T3). HBF and hemodynamic measurements were performed simultaneously at these three time-points. Results A total of 28 patients were analyzed. Administration of NE significantly increased MAP but had no effect on cardiac index. NE infusion reduced total HBF in all patients (p < 0.01) by a reduction HAF (p < 0.01), while the effect on PVF remained unclear. Post-hoc analysis showed that SOMATO-treated patients had a significant lower PVF at baseline (p < 0.05), which did not change during NE infusion. In these patients, reduction of total HBF was primarily related to a reduction of HAF (p < 0.01). In untreated patients, NE infusion reduced total HBF both by a reduction HAF (p < 0.01) and PVF (p < 0.05). Conclusion Administration of NE reduced total HBF, by decreasing HAF, while the effect on PVF remained unclear. SOMATO-treated patients had a lower PVF at baseline, which remained unaffected during NE infusion. In these patients the decrease in total HBF with NE was entirely related to the decrease in HAF. In SOMATO-untreated patients PVF also significantly decreased with NE. Trial registration Study protocol EC: 2019/0395. EudraCT n°: 2018–004,139-66 (25 – 03 – 2019). Clin.trail.gov: NCT03965117 (28 – 05 – 2019). |
| first_indexed | 2024-04-13T15:24:39Z |
| format | Article |
| id | doaj.art-96e0747689a24d2294e65541660c4ee1 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-13T15:24:39Z |
| publishDate | 2022-07-01 |
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| series | BMC Anesthesiology |
| spelling | doaj.art-96e0747689a24d2294e65541660c4ee12022-12-22T02:41:33ZengBMCBMC Anesthesiology1471-22532022-07-0122111110.1186/s12871-022-01741-2Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort studyJurgen van Limmen0Xavier Iturriagagoitia1Marilie Verougstraete2Piet Wyffels3Frederik Berrevoet4Luís Filipe Abreu de Carvalho5Stefan De Hert6Luc De Baerdemaeker7Department of Anesthesiology and Perioperative Medicine, Ghent University HospitalDepartment of Anesthesiology and Perioperative Medicine, Ghent University HospitalDepartment of Anesthesiology and Perioperative Medicine, Ghent University HospitalDepartment of Anesthesiology and Perioperative Medicine, Ghent University HospitalDepartment of General and Hepatic-Pancreatico-Biliary Surgery and Liver Transplantation, Ghent University HospitalDepartment of General and Hepatic-Pancreatico-Biliary Surgery and Liver Transplantation, Ghent University HospitalDepartment of Anesthesiology and Perioperative Medicine, Ghent University HospitalDepartment of Anesthesiology and Perioperative Medicine, Ghent University HospitalAbstract Background Norepinephrine (NE) is a α1-adrenergic mediated vasopressor and a key player in the treatment of perioperative hypotension. Apart from modulating systemic hemodynamics, NE may also affect regional blood flow, such as the hepatic circulation, which contains a wide variety of adrenergic receptors. It may alter regional vascular tonus and hepatic blood flow (HBF) by reducing portal vein flow (PVF) or hepatic arterial flow (HAF). The aim of this study was to assess the effects of NE on HBF. Methods Patients scheduled for pancreaticoduodenectomy were included. All patients received standardized anesthetic care using propofol and remifentanil and were hemodynamically stabilized using a goal-directed hemodynamic strategy guided by Pulsioflex™. On surgical indication, somatostatin (SOMATO) was given to reduce pancreatic secretion. HBF measurements were performed using transit-time ultrasound (Medistim™). Baseline hemodynamic and HBF measurements were made after pancreatectomy, at T1. Afterwards, NE infusion was initiated to increase mean arterial pressure (MAP) by 10 – 20% of baseline MAP (T2) and by 20 – 30% of baseline MAP (T3). HBF and hemodynamic measurements were performed simultaneously at these three time-points. Results A total of 28 patients were analyzed. Administration of NE significantly increased MAP but had no effect on cardiac index. NE infusion reduced total HBF in all patients (p < 0.01) by a reduction HAF (p < 0.01), while the effect on PVF remained unclear. Post-hoc analysis showed that SOMATO-treated patients had a significant lower PVF at baseline (p < 0.05), which did not change during NE infusion. In these patients, reduction of total HBF was primarily related to a reduction of HAF (p < 0.01). In untreated patients, NE infusion reduced total HBF both by a reduction HAF (p < 0.01) and PVF (p < 0.05). Conclusion Administration of NE reduced total HBF, by decreasing HAF, while the effect on PVF remained unclear. SOMATO-treated patients had a lower PVF at baseline, which remained unaffected during NE infusion. In these patients the decrease in total HBF with NE was entirely related to the decrease in HAF. In SOMATO-untreated patients PVF also significantly decreased with NE. Trial registration Study protocol EC: 2019/0395. EudraCT n°: 2018–004,139-66 (25 – 03 – 2019). Clin.trail.gov: NCT03965117 (28 – 05 – 2019).https://doi.org/10.1186/s12871-022-01741-2NorepinephrineLiver circulationHepatic blood flowSomatostatin |
| spellingShingle | Jurgen van Limmen Xavier Iturriagagoitia Marilie Verougstraete Piet Wyffels Frederik Berrevoet Luís Filipe Abreu de Carvalho Stefan De Hert Luc De Baerdemaeker Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study BMC Anesthesiology Norepinephrine Liver circulation Hepatic blood flow Somatostatin |
| title | Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study |
| title_full | Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study |
| title_fullStr | Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study |
| title_full_unstemmed | Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study |
| title_short | Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study |
| title_sort | effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin an observational cohort study |
| topic | Norepinephrine Liver circulation Hepatic blood flow Somatostatin |
| url | https://doi.org/10.1186/s12871-022-01741-2 |
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