Abstract
BackgroundTerlipressin, in general, is a vasopressor which acts via V1 receptors. Its infusion elevates mean blood pressure and can reduce bleeding which has a splanchnic origin. The primary outcome was to assess the impact of intraoperative terlipressin infusion on portal venous pressure during hepatobiliary surgery; the 2ry outcomes included effects upon systemic hemodynamics, estimated blood loss, and postoperative renal functions.MethodsThis prospective randomized study involved 50 patients undergoing hepatobiliary surgery who were randomly and equally allocated into terlipressin group, or a control group. The terlipressin group received an initial bolus dose of (1 mg over 30 min) followed by a continuous infusion of 2 μg/kg/h throughout the procedure and gradually weaned over the first four postoperative hours, whereas the control group received the same volumes of normal saline. The portal venous pressure changes were measured directly through a portal vein angiocatheter.ResultsPortal pressure was significantly reduced over time in the terlipressin group only (from 17.88 ± 7.32 to 15.96 ± 6.55 mmHg, p < .001). Mean arterial blood pressure was significantly higher in the terlipressin group. Estimated blood loss was significantly higher in the control group than the terlipressin group (1065.7 ± 202 versus 842 ± 145.5 ml; p = 0.004), and the units of packed RBCs transfused were significantly higher in the control group ((0–2) versus (0–4) p = 0.003). There was no significant difference between groups as regards the incidence of acute kidney injury.ConclusionIntraoperative infusion of terlipressin during hepatobiliary surgery was shown to improve intraoperative portal hemodynamics with subsequent reduction in blood loss.Trial registrationClinical trial number and registry URL: Trial registration number: NCT02718599. Name of registry: ClinicalTrials.gov. URL of registry: https://clinicaltrials.gov/ct2/show/NCT02718599. Date of registration: March 2016. Date of enrolment of the first participant to the trial: April 2016.
Highlights
Terlipressin, in general, is a vasopressor which acts via V1 receptors
We hypothesize that the terlipressin induced splanchnic vasoconstriction could reduce portal pressure, decrease blood loss, and improve postoperative renal function
There were no significant differences between both groups regarding demographic data, clinical and perioperative characteristics, comorbid risk factors, surgery type or its duration, nor the Intensive Care Unit (ICU) stay days (Table 1)
Summary
Terlipressin, in general, is a vasopressor which acts via V1 receptors. Its infusion elevates mean blood pressure and can reduce bleeding which has a splanchnic origin. The primary outcome was to assess the impact of intraoperative terlipressin infusion on portal venous pressure during hepatobiliary surgery; the 2ry outcomes included effects upon systemic hemodynamics, estimated blood loss, and postoperative renal functions. Intraoperative blood volume loss as little as 10 to 15% could result in splanchnic hypoperfusion, which usually persists during the period of hypovolemia [1] This results in an intramucosal acidosis of the gut leading to a cascade of events that impair postoperative gastrointestinal function and cause complications [2,3,4]. We hypothesize that the terlipressin induced splanchnic vasoconstriction could reduce portal pressure, decrease blood loss, and improve postoperative renal function
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