*Corresponding author:Nahla Kamel Gaballa, Department of Anaesthiology, Menoufiya University, Shibin El Kom, Egypt
Received: June 17, 2017 Published: July 03, 2017
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Objective: To study the perioperative effect of Dexmedetomidine on indirect calorimetry in recipients of adult living donor liver transplantation.
Background: Dexmedetomidine is newly used in liver transplant.
Material and Methods: forty patients were assigned randomly to get Dexmedetomidine (Dex) beginning at 0.5 μg/kg/h(0.2-0.7μg/ kg/h) or placebo (C) Anesthesia was guided by Enotropy (40-60) with Desflurane. Indirect calorimetry parameters, arterial blood gasses, hemodynamics were taken at base line, dissection, an hepatic, reperfusion and 3 hours after end of operation. Transoesophageal Doppler was used for fluid optimization.
Results: No significant difference was noticed in either group regarding demographic data, and operative data , Dexmedetomidine affects oxygen consumption(Vo2) and carbon dioxide production (Vco2) significantly at at reperfusion and 3hours postreperfusion; Mean ±SD for VO2 (273.1±36.1/227.1±82), (252.4 ±39/189.5±75) ml/min/m2 and P=0.019,0.005 for control /DEX groups at reperfusion and intensive care unit(I.C.U)respectively , VCO2(238.4±18/181.5±72), (210.5±27/159.0±63) ±78.77 ml/min/m2:p =0.002, 0.001 also for control /DEX respectively. Respiratory Quotient RQ and Energy expenditure EE were significant in C versus DEX at reperfusion and in intensive care, for RQ in C/DEX (0.7 9±0.08/0.73±0.08),(0.75±0.8/0.70±0.10) with p=0.014,0.001. EE for C/DEX (1358.5±152.4/1231.5±84.9), (1264.3±147.0/1068.1±122.9) and P=0.000, 0.001 sequentially. Haemodynamics were insignificantly decreased in DEX versus C .DEX decreased the utilization of desflurane in DEX/C (179±59/221±5 p=0.016) ml, fentanyl (988±202/1241±390p=0.041) μg, and insignificantly increased amounts of fluids needed and the in otropic support. pH and Paco2,HCO3 were insignificantly affected in both groups, except in reperfusion, where pH and HCO3 decreased and Paco2 increased significantly. The I.C.U. stay was comparable.
Conclusion: dexmedetomidine has a depressing effect on indirect calorimetry especially in reperfusion.
Keywords: Dexmedetomidine; Indirect Calorimetry; Liver Transplant
Abbreviations: Dex: Dexmedetomidine; ICU: Intensive Care Unit; TED: Transesophageal Doppler; CO: Cardiac Output; SVR: Systemic Vascular Resistance; ROTEM: Rotational Thromboelastography; BL: Baseline; DISS: During Dissection; ANH: Anhepatic; REP: Reperfusion Phases; SPSS: Statistical Package for Social Science; HR: Heart Rate; NLI: National Liver Institute; MAC: Minimal Alveolar Concentration.
Introduction | Patient and Methods | Results | Discussion | Conclusion and Recommendations | Acknowledgment | Funding Statement | Data Availability | Sponsor for Corresponding Author | References | Figures | Tables |