Low-dose dopexamine in patients undergoing hemihepatectomy: an evaluation of effects on reduction of hepatic dysfunction and ischaemic liver injury

Background: Hepatic dysfunction is a common problem in patients after hemih epatectomy. Treatment with low-dose dopamine has been shown to be beneficia l in hemihepatectomy patients. We hypothesized that dopexamine, a synthetic vasoactive catecholamine, due to its specific pharmocodynamic profile may be more effective in reducing hidden ischaemic episodes in the hepato-splan chnic region during and after temporary total cross-clamping of hepatic inf low in these patients. Methods: The effects of low-dose dopexamine on hepatic venous haemoglobin o xygen saturation (ShvO(2)), hepatic venous lactate level, monoethylglycinxy lid (MEGX) formation, hepatic synthetic function and indicators for hepatic cell damage were studied during hemihepatectomy and for 16 h postoperative ly in hemihepatectomy patients and compared to those of low-dose dopamine. In a prospective, double-blind clinical study 20 patients received randomly either dopexamine (DPX) 0.5 mu g kg(-1) min(-1) (n=10) or dopamine (DO) 2. 5 mu g kg(-1) min(-1) (n=10). Infusions were started after induction of ana esthesia and continued 16 h postoperatively. Hepatic vein, radial and pulmo nary artery were catheterized. Measurements were carried out after inductio n of anaesthesia, after total cross-clamping of hepatic inflow, and at 2 h and 16 h postoperatively. Results: There were no differences in systemic haemodynamics, oxygenation, ShvO(2) serum aminotransferases or MEGX levels between the groups. At 16 h postoperatively prothrombin and antithrombin III levels were significantly lower while hepatic venous lactate was significantly higher in the DPX grou p compared to the DO group, Conclusion: In patients undergoing hemihepatectomy, we could not reveal sup erior hepatoprotective effects of low-dose dopexamine compared to low-dose dopamine. (C) Acta Anaesthesiologica Scandinavica 44 (2000).