Introduction. A number of investigators have identified that terlipressin
reduces portal blood flow. Terlipressin, a long-acting synthetic analogue
of arginine vasopressin, acts through V1 receptors mainly in the splanchnic
circulation, which causes vasoconstriction with subsequent reduction in
portal pressure. The objective of this study was to evaluate the safety of
preoperative use of terlipressin and its impact on the blood loss in patients
undergoing liver resections.
Materials and Methods. This was a prospective, randomized study. 60
patients (20-79 years) undergoing left or right hemihepatectomy, liver
segmentectomy and atypical resections were randomized via computergenerated
random numbers into 2 groups: 1) control group (CON) n=30 2)
terlipressin group (TER) n=30. Patients in TER group were given IV bolus
of terlipressine 1 mg in 30 minutes before anesthetic induction. In CON
group patients received at the same time saline solution.
Results. Patients in the 2 groups were comparable with respect to age,
sex, body weight, height, ASA status, type and duration of surgery.
Preoperative laboratory tests were not different between the groups.
Analysis of the intraoperative hemodynamics showed that, mean arterial
pressure (MAP) during anesthesia did not differ between the groups.But the perioperative heart rate (HR) in TER group was significantly
reduced versus CON group at the time after laparotomy (p<0,05). Estimated blood loss was significantly lower in the TER group than in
the CON group, therefore patients in the TER group needed greater volume
of the colloids solutions. At the same time we did not find significant
differences in transfusion of packed red blood cells and FFP (fresh frozen
plasma). Urinary output during anesthesia was significantly decreased in
TER group versus CON group.At the first postoperative day the level of hemoglobin in group TER was significantly higher than that in CON group. There were no other differences in the postoperative laboratory tests between the groups.
Discussion. In our study intraoperative use of terlipressin significantly
reduced mean blood loss, as a result postoperative level of hemoglobin was
higher in group TER than in group CON. Intraoperative use of terlipressin
did not impact on hemodynamics parameters and other laboratory tests.
According to data of the other investigations the use of terlipressin can
improve renal function without any detrimental effect on hepatosplanchnic
gas exchange and lactate metabolism, and an infusion
of terlipressin perioperatively has no effect on the creatinine values
postoperatively. In our study terlipressine incrieased intraoperative urine
output, but did not impact on postoperative creatinine level.

The effects of preoperative use of terlipressin in patients undergoing liver resections