Perioperative Effect of Continuous Infusion of Dexmedetomedine on Indirect Gas Calorimetry Monitoring in Liver Transplantation

Magdy K Khalil², Mohamed H Afifi¹, Essam A Ismael¹, Nirmen A Fayed² and Nahla K Gaballa²*

DOI: 10.26717/BJSTR.2017.01.000163

Received: June 17, 2017   Published: July 03, 2017

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Abstract

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 |