The effect of fenoldopam and dopexamine on hepatic blood flow and hepatic function following coronary artery bypass grafting with hypothermic cardiopulmonary bypass

Abstract

Fenoldopam infusion induced transient tachycardia, with no augmentation of hepatic blood flow whereas dopexamine induced tachycardia and did not augment hepatic blood flow. Fenoldopam and dopexamine may have hepato-protective effect.

A Comparison of Doubutamine and Levosimendan on Hepatic Blood Flow in Patients with a Low Cardiac Output State after Cardiac Surgery: A Randomised Controlled Study

“…the three determinants of lBF are intestinal vascular resistances that determine the intestinal flow and portal vein flow, the arteriolar resistances in the territory of the hepatic artery and the intrahepatic resistances to portal flow that are less important than mesenteric resistances 24 . Furthermore, there is a buffer mechanism in the hepatic arterial circulation that forms a feedback between the portal flow and vascular resistances in the hepatic artery so that when PVQ increases the resistance of the hepatic artery also increases 21,[24][25][26][27] . On the other side, the arterial liver circulation lacks self-regulation which means that the relationship between perfusion pressure of the liver and lBF flow is linear.…”

“…However, there are also other mechanisms that can affect liver flow in patients undergoing major general and cardiac surgery 1,4,5 including the effect of halogenated anaesthetics 8 , assisted ventilation 1,28 and short-term haemodynamic fluctuations that reduce lBF. the effect of other drugs on lBF with a potent systemic vasodilator capacity is variable.…”

“…Mild hepatic dysfunction in the form of transient mild derangements in liver function tests in the postoperative period is very frequent and can occur in up to 47% of patients after cardiac surgery. Moderate hepatic dysfunction is defined by the presence of jaundice and a serum bilirubin concentration above 51.3 µmol/l and occurs in 3.2% of all patients after CPB 1,2 . Risk factors for moderate hepatic dysfunction may include gender, New York Heart Association class status of advanced cardiac failure, type and duration of surgery, a low cardiac output state requiring inotropic agents and/or intra-aortic balloon pump, cardiac arrest, cardiac tamponade and massive blood transfusion.…”

Effect of increased pump flow on hepatic blood flow and systemic inflammatory response following on-pump coronary artery bypass grafting

“…# = PDR -Percentage disappearance rate t 1/2 -Half life for clearance of the dye measured in minutes Calculating the PDR rather than the clearance itself eliminates the need to ensure that an accurate dose of ICG was given, since clearance is calculated from the product of elimination rate constant (log e 2/t 1/2 ) and the volume of distribution (dose of dye/concentration at time zero) 6 .…”

“…Cardiac output during CPB remains completely dependant on the pump flow, particularly following application of the crossclamp. In an earlier study, we have demonstrated that pharmacological agents like dopexamine and fenoldopam (another DA-1 receptor agonist) do not increase hepatic blood flow 6 . Limited studies have examined the effects of higher pump flow on cerebral blood flow 7 , renal function in humans 8 and splanchnic perfusion in rabbits 9,10 .…”