Abstract

Background: Goal-directed hemodynamic therapy (GDHT) is applied to optimize cardiac output and perfusion in patients undergoing major abdominal surgery. Dobutamine (DOBU) and norepinephrine (NOR) are commonly used agents with distinct systemic profiles, yet their comparative effects on hepatic blood flow (HBF) remain underexplored.

Objectives: To compare the effects of DOBU and NOR on hepatic and systemic hemodynamics during major abdominal surgery.

Design and Setting: Prospective observational study conducted in a tertiary academic center on patients undergoing elective pancreaticoduodenectomy.

Methods: Two observational cohorts were analyzed. One group received titrated doses of NOR to achieve a targeted increase in mean arterial pressure (MAP), while the other received incremental doses of DOBU. Hemodynamic parameters—including portal vein flow (PVF), hepatic artery flow (HAF), and total HBF—were measured using intraoperative transit-time flow measurement. Measurements were obtained at baseline and following two predefined dose escalations.

Main Outcome Measures: Changes in indexed PVF, HAF, and HBF, as well as cardiac index (CI), heart rate (HR), and MAP.

Results: DOBU significantly increased CI and HR, with a corresponding rise in PVF and total HBF, but reduced HAF at higher doses. NOR induced a dose-dependent increase in MAP but significantly reduced total HBF due to decreased HAF, without notable changes in CI or PVF.

Conclusions: DOBU enhances total HBF primarily via increased cardiac output but at the cost of tachycardia. NOR maintains MAP effectively but may compromise HBF due to vasoconstrictive effects. These findings support a tailored vasoactive strategy in perioperative management, especially in patients at risk for hepatic dysfunction.