Fenoldopam and gastric tonometry during orthotopic liver transplantation.

Author(s): Pugliese F, Ruberto F, Bruno K, Martelli S, Perrella S, Cappannoli A, D'Alio A, Messina T, Summonti D, Pietropaoli C, Rossi M, Novelli G, Berloco PB, Pietropaoli P

Affiliation(s): Dipartimento di Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Universita dedegli studi di Roma La Sapienza Universita' Degli Studi di Roma La Sapienza, Roma, Italy. mavif@tiscali.it

Publication date & source: 2007-07, Transplant Proc., 39(6):1886-8.

Publication type: Randomized Controlled Trial

The aim of this study was to evaluate the effects of continuous infusion of fenoldopam on splanchnic perfusion in orthotopic liver transplant (OLT) recipients. PATIENTS AND METHODS: We enrolled 40 patients of mean age 57+/-16 years who underwent (OLT). They were randomly divided into two double blinded groups; continuous fenoldopam (0.06 mcg/kg per minute) or placebo infusion. Hemodynamics, gastric tonometry, urine output, renal function parameters, and diuretics use were collected during selected phases of the surgery and postoperatively every 12 hours for 72 hours in the intensive care unit. RESULTS: No significant differences were observed between the two groups concerning hemodynamics, though in the fenoldopam group we observed increased splanchnic perfusion during the whole study period but particularly after arterial unclamping (pHi 7,31+/-0.04 vs 7.28+/-0.05; P < .05) and at 48 hours after surgery (pHi 7.49+/-0.15 vs 7.39+/-0.15; P < .05). Creatinine and blood urea nitrogen values were slightly higher in the placebo group, but this data did not reach statistical significance, while higher doses of furosemide were administered to the placebo group to maintain a urinary output over 200 mL/hour during the whole study. DISCUSSION: In this study we observed that continuous fenoldopam infusion (0.06 mg/kg per minute) improved splanchnic perfusion without affecting systemic pressure. CONCLUSION: Patients undergoing OLT have altered splanchnic perfusion related to cirrhosis, surgical manipulation, and fluid shifts during and after surgery. The use of a splanchnic vasodilator drug improved outcomes in these patients.