Effects of terlipressin infusion during hepatobiliary surgery on systemic and splanchnic haemodynamics, renal function and blood loss: a double-blind, randomized clinical trial

Magdy Mohammed Mahdy, Mostafa Samy Abbas, Emad Zarief Kamel, Mohamed Fathy Mostafa, Ragaa Herdan, Shimaa Abbas Hassan, Ramy Hassan, Ahmed M Taha, Tameem M Ibraheem, Bashir A Fadel, Mohammed Geddawy, Jehan Ahmed Sayed, Osama Ali Ibraheim, Magdy Mohammed Mahdy, Mostafa Samy Abbas, Emad Zarief Kamel, Mohamed Fathy Mostafa, Ragaa Herdan, Shimaa Abbas Hassan, Ramy Hassan, Ahmed M Taha, Tameem M Ibraheem, Bashir A Fadel, Mohammed Geddawy, Jehan Ahmed Sayed, Osama Ali Ibraheim

Abstract

Background: 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.

Methods: This 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.

Results: Portal 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.

Conclusion: Intraoperative infusion of terlipressin during hepatobiliary surgery was shown to improve intraoperative portal hemodynamics with subsequent reduction in blood loss.

Trial registration: Clinical trial number and registry URL: Trial registration number: NCT02718599 . Name of registry: ClinicalTrials.gov. URL of registry: https://ichgcp.net/clinical-trials-registry/NCT02718599 . Date of registration: March 2016. Date of enrolment of the first participant to the trial: April 2016.

Keywords: Blood loss; Hemodynamics; Portal pressure; Terlipressin.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Intraoperative changes in the portal vein. Caption; (a)portal venous pressure, (b) Portal venous pH, (c) Portal venous partial pressure of CO2, (d) portal venous blood lactate level. Data are presented as mean ± SD. (*) significant change from the baseline value. P-value < 0.05 was considered statistically significant

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