Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationship between oxygen consumption (VO2) and oxygen delivery (DO2) is of interest in critically ill patients. Various studies of these parameters have resulted in different concepts for optimizing DO2 and VO2. During liver transplantation without anhepatic veno-venous bypass, caval cross-clamping initiates a series of haemodynamic and metabolic alterations including the rapid change from hyperdynamic to hypodynamic conditions. In addition, simultaneous changes in DO2 and VO2 occur in these patients. The goal of our present study was to test the clinical relevance of therapeutic interventions based on metabolic monitoring in patients with terminal liver disease undergoing orthotopic liver transplantation. PATIENTS AND METHODS. One hundred sixty-two consecutive patients were evaluated. According to outcome, patients were divided into survivors (n = 115, group A), nonsurvivors (n = 30, group B), and patients with primary nonfunction of the liver graft (n = 17, group C). One hundred twenty patients were cirrhotics due to either alcohol (n = 36), aggressive hepatitis (n = 30), or biliary cirrhosis (n = 54); 42 had a neoplastic disease. Haemodynamic measurements, data for calculations of DO2 and VO2, and blood samples for arterial and mixed-venous blood gases and subsequent laboratory analysis were taken during the surgical procedure at six timepoints: after induction of anaesthesia (I); during preparation of the recipient liver, before cross-clamping (II); 10 min after clamping of the inferior vena cava (III); 10 min before unclamping (IV); with all vessels open, 10 min after declamping during reperfusion (V); and 60 min after declamping (VI). Anaesthesia was induced with thiopentone (3-5 mg/kg i.v.) and fentanyl (15 micrograms/kg min i.v.). Muscle relaxation was achieved with pancuronium (0.1 mg/kg i.v.). Anaesthesia was maintained with i.v. supplements of fentanyl (5-10 micrograms/kg) and pancuronium (4 mg) as required. Volume-cycled ventilation was established with a mixture of O2 in air with a positive end-expiratory pressure of 5 mm H2O to keep the PaO2 above 100 mm Hg and the PaCO2 around 35 mm Hg (Servo 900 C-Ventilator, Siemens). To maintain body temperature, all patients were positioned on a heating blanket set at 38 degrees C. The inspired gases were warmed and humidified using a dual servo-heated humidifier. Mannitol (20-40 g i.v.) or sorbitol (16-24 g i.v.) was given to prevent renal dysfunction during the cross-clamping procedure. Lactated Ringer's solution and fresh frozen plasma administration was guided by cardiovascular performance and requirements for clotting factors, respectively. Cardiac output was measured by the thermodilution method using a pulmonary artery catheter. Blood lactate, haemoglobin concentration, arterial and mixed-venous oxygen content, and oxygen saturation were measured (Hemoxymeter OSM3). VO2 and DO2 were calculated according to standard formulas. STATISTICAL ANALYSIS. The data from groups A, B, and C were compared using a multivariate analysis of variance with Tukey's method for multiple comparisons. A least-square regression was used to correlate metabolic data. RESULTS. The perioperative course of the determinants of oxygen transport is shown in Table 1. After cross-clamping, the cardiac index (CI) decreased in groups A (47%), B (53%), and C (51%) and increased to pre-anhepatic levels after reperfusion of the new liver. This was associated with distinct decreases in DO2 (A: 42%, B: 47%, and C: 45%) and VO2 (A: 8%, B: 19%, C: 25%). After reperfusion of the new allograft (V), VO2 increased in groups A (24%) and B (18%) as compared to controls (I). By contrast, in group C, a distinct further decrease in VO2 (13%) was detected. In these patients, there was a significantly greater increase in mixed-venous saturation accompanied by a further decrease in body temperature. As shown in Figures 1 and 2, no significant relationship was found between O2 transport, VO2, and blood lactate. DISC
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PMID:[Anesthesia-relevant changes in metabolic parameters with different circulatory and liver functions]. 152 56

Etomidate is a useful addition to the list of available anesthetic agents. When faced with an animal with cardiovascular instability, cirrhosis, an intracranial lesion, susceptibility to malignant hyperthermia, anaphylactoid tendencies, or one that requires cesarean section, one should consider using etomidate. In addition, it provides a safe method for total intravenous anesthesia in situations in which the nature of the surgery precludes the use of an endotracheal tube, when the use of an inhalant is undesirable for any reason, or when inhalant anesthetic equipment is unavailable.
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PMID:Advantages of etomidate use as an anesthetic agent. 158 53

This study was performed to investigate modifications in the serum bilirubin forms, hepatobiliary enzymes, and some glycoproteic substances in patients during the course of extrahepatic cholestasis (stage A) and following its clinical resolution (stage B). The series consisted of 16 patients: 11 had main bile duct stones; two, benign stenosis of the main bile duct; and three, main bile duct cancer. Cholestasis resolved spontaneously in one case, under endoscopy in two, and following surgery in 13. Five patients with liver cirrhosis and a picture of intrahepatic cholestasis following anesthesia were also investigated. Serum bilirubin forms were measured using van den Bergh's method and the alkaline methanolysis-HPLC procedure; the mono- and di-conjugated forms were considered together in the overall evaluation of the results. The hepatobiliary enzymes (ALP, GGT, and AST) were increased at stage A and significantly decreased at stage B. Similar patterns were observed in total (TB), unconjugated (UB), and conjugated bilirubin (CB) and in the percentage of CB out of TB (% CB). In the majority of patients, % CB at stage B was lower than at stage A, whereas in subjects with a high initial UB value, a different % CB pattern was observed. The direct bilirubin percentage (% DB), on the other hand, had a different pattern, and the variations between stages A and B were not significant. The pathophysiological bilirubin pattern was similar in patients with intrahepatic cholestasis. At stage A, in a number of patients the levels of glycoproteic substances (CA 19-9, TPA and ferritin) were raised, but at stage B they tended to decrease towards the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Alterations in bilirubin metabolism during extra- and intrahepatic cholestasis. 160 Mar 31

The pharmacokinetics of etomidate were studied in 9 control subjects (with normal liver function) and in 5 patients with cirrhosis scheduled for gastro-intestinal surgery. Anaesthetic induction included an initial bolus of etomidate 0.3 mg.kg-1, together with fentanyl 2 micrograms.kg-1, and pancuronium 60 micrograms.kg-1. An etomidate infusion was then started according to one of two following schemes: a (0.03 mg.kg-1.min-1 for 10 min, and then 0.01 mg.kg-1.min-1), or B (0.1 mg.kg-1.min-1 for 10 min, followed by 0.02 mg.kg-1.min-1 for a further 110 min, and 0.01 mg.kg-1.min-1 thereafter). Plasma concentrations of etomidate were determined at regular intervals throughout anaesthesia, and up to four hours afterwards, using inverse phase high pressure liquid chromatography. The infusion was given for 273 +/- 87 min in controls, and for 259 +/- 56 min in the cirrhotic group. Scheme A, only used in 3 controls and 1 cirrhotic in a preliminary study, resulted in very low plasma concentrations: 0.2 to 0.4 micrograms.ml-1. Those measured during the apparent plateau phase (steady state) of infusion protocol B were close to predicted values (0.5 to 0.6 micrograms.ml-1) in controls, whereas higher concentrations (approximately 1.5 micrograms.ml-1) were reached in cirrhotic patients. For all the patients the time interval to spontaneous recovery was 41 +/- 27 min; plasma levels were then 0.199 +/- 0.092 micrograms.ml-1. There were significant alterations in pharmacokinetic parameters in the cirrhotic patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pharmacokinetics of continuous infusion of etomidate in cirrhotic patients]. 175 54

Four pharmacons were tested on an acute portal pressure lowering effect in an experimental animal model with 25 normal and 25 rats with Thioacetamide-toxic liver cirrhosis. Invasive measurements of arterial and portal pressure were made under Hexobarbital-Sodium anaesthesia during 30 minutes after pharmacon application. The portal pressure of cirrhotic rats was under basic conditions 9.5 +/- 1.5 mm Hg and significant higher as in normal animals (5.3 +/- 0.9 mm Hg, p less than 0.01). After 10 mg/kg body mass Propranolol the portal pressure decreased in both animal groups small but not significantly over the whole measurement time. 1 mg/kg Verapamil lowered arterial middle pressure significantly, but increased portal pressure at all 15-20% in both animal groups. Application of 0.1 mg/kg Prazosin decreased the arterial middle pressure at all 5-15% and the portal pressure at all 20-30% in both study groups (both significantly). For Canrenoat-Potassium (20 mg/kg) no clear effect could by evaluated on portal pressure. The model of Thioacetamide-toxic cirrhosis of the rat offers conditions like cirrhosis in human medicine in order to study the effects of portal pressure lowering pharmacons. Propranolol and Prazosin decrease portal pressure and should by further investigated.
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PMID:[Pharmacological lowering of portal pressure in normal rats and in experimental liver cirrhosis]. 181 60

Portasystemic (PS) shunts have been regarded as a relative contraindication to hepatic transplantation (HT) because of the potential for increased technical difficulties during the transplant operation. We compared operative blood loss, morbidity and mortality in 27 patients with PS shunts and 147 patients with no shunts (NS) who underwent HT. The PS shunt group included 12 portocaval (PC), eight mesocaval, four central splenorenal and four distal splenorenal shunts. The PS shunt and NS groups were similar with respect to age, preoperative medical status and ABO blood group matching between donors and recipients. There were no significant differences in the mean (plus or minus S.D.) intraoperative blood transfusion (9.1 +/- 7.6 versus 9.2 +/- 11.0 units), mean (plus or minus S.D.) duration of anesthesia (8.1 +/- 1.4 versus 7.8 +/- 1.5 hours) and operative mortality (7 versus 11 per cent) between the PS shunt and NS groups, respectively. Complications of the biliary tract were significantly higher in the PS shunt group (22.0 versus 5.4 per cent, p less than 0.01) but they did not increase the mortality rate. We conclude that a prior PS shunt should not influence the decision to accept patients for HT. PS shunts remain a reasonable surgical option for patients with cirrhosis and variceal hemorrhage (refractory to sclerotherapy) who, by virtue of good hepatic function, do not merit immediate HT.
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PMID:Effect of portasystemic shunts on subsequent transplantation of the liver. 199 97

The pharmacokinetic profile of methohexital was studied in cirrhotic patients (n = 8), patients undergoing upper abdominal surgery (n = 8) and orthopaedic patients under general anaesthesia (n = 8). The total plasma clearance of methohexital was unchanged in cirrhotics: 54 +/- 22 l.h-1 (mean +/- s.d.) as well as in patients undergoing upper abdominal surgery: 60 +/- 14 l.h-1 in comparison to orthopaedic surgery: 70 +/- 24 l.h-1. The central volume and total volume of distribution and the distribution and elimination half-lives were similar between the three groups. Despite its hepatic dependent elimination, methohexital elimination kinetics were unchanged in patients undergoing upper abdominal surgery and in cirrhosis. Owing to the high hepatic extraction ratio of methohexital, its elimination should be influenced by the hepatic blood flow. The unchanged elimination kinetics presently observed in patients with cirrhosis or those undergoing upper abdominal surgery suggest that the hepatic blood flow is less diminished than expected in these patients.
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PMID:Effect of upper abdominal surgery and cirrhosis upon the pharmacokinetics of methohexital. 202 66

Central nervous system (CNS)-induced natriuresis was investigated in nonascitic rats with CCl4-induced cirrhosis (CTC rats) under pentobarbital anesthesia. At baseline, urine sodium output (UNa+V, in mumol.min-1.100 g body wt-1) (-30%, P less than 0.01) and mean arterial pressure (MAP, in mmHg) (-12%, P less than 0.001) were significantly reduced in CTC rats (n = 32) compared with matched controls (n = 34). In response to intracerebroventricular infusion of sodium-rich (349 mM) artificial cerebrospinal fluid (Na(+)-CSF infusion), UNa+V was significantly higher in CTC rats (2.8 +/- 0.3; n = 15) than in controls (1.7 +/- 0.2; n = 17; P less than 0.01); no differences were found in pressor changes (24 +/- 3 vs. 19 +/- 2). A similar but normal sodium CSF (150 mM) infusion did not influence UNa+V or MAP in any group (n = 12, both). In contrast, CTC rats (n = 5) showed, compared with controls (n = 5), significantly reduced natriuretic (UNa+V, 6.9 +/- 0.5 vs. 12.4 +/- 0.9; P less than 0.001) and pressor (+16 +/- 3 vs. +31 +/- 2; P less than 0.01) responses to an intravenous hypertonic sodium overload. Natriuresis induced by Na(+)-CSF infusion was related to increases in creatinine clearance (similar in both groups) and in fractional sodium excretion, which was significantly higher in CTC rats (5.90 +/- 0.15%) than in controls (3.65 +/- 0.14%; P less than 0.01). In summary, CNS-dependent efferent natriuretic mechanisms were preserved in CTC rats and were able to reverse renal tubular sodium retention in these animals. It is proposed that Na(+)-CSF infusion may be a useful tool for the study of renal sodium retention in experimental liver cirrhosis.
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PMID:Enhanced responsiveness to CNS-induced natriuresis in anesthetized nonascitic cirrhotic rats. 205 81

In November 1989, transplantation of a liver graft from a living related donor was performed at Shimane Medical University Hospital. The donor was a 26-year-old man and the recipient his 1-year-old son. The child had been in end stage of liver cirrhosis. Before the surgery, he required intensive care because of massive bleeding from varices. Anesthesia of the recipient was rapidly induced with ketamine and the trachea was intubated with succinylcholine using cricoid pressure. Anesthesia was maintained with enflurane, fentanyl and pancuronium. Nitrous oxide was used only in the preanhepatic period. Total surgical time and anesthetic time were 945 min and 1065 min, respectively. Total estimated blood loss was 3650 ml and 2780 ml of fresh whole blood was transfused. Careful attention was paid to body temperature, serum potassium, ionized calcium and blood coagulation function, as well as to general cardiovascular and respiratory functions. During anhepatic period, the inferior caval vein was not clamped. Hemodynamic function was relatively stable throughout the operation. At the time of reperfusion of the transplanted graft, there was little change in serum potassium levels or other parameters. Postoperative mechanical ventilation was required for 8 days.
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PMID:[A case report of anesthetic management of orthotopic liver transplantation from a living donor to his son]. 207 99

Patients with liver disease requiring surgical procedures are at increased perioperative risk. In addition, the deleterious effect of anesthesia on hepatocellular function, altered drug pharmacokinetics, aberrant hemostasis, postoperative encephalopathy and infection, with multiorgan failure, all contribute to perioperative morbidity and mortality. Although limited by the lack of widely accepted quantitative liver function tests, preoperative evaluation and risk assessment is imperative. Acute viral hepatitis, alcoholic hepatitis, refractory coagulopathy, Child's class C cirrhosis, and emergent surgery are major risk factors predictive of a poor outcome. In addition, elective abdominal surgical procedures should be avoided in potential candidates for orthotopic liver transplantation. Identification and correction of reversible risk factors via meticulous preoperative definition of the etiology, chronicity, and severity of the patient's liver disease within the confines of surgical urgency is the goal of the preoperative hepatology consultation.
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PMID:Hepatologic considerations in patients with parenchymal liver disease undergoing surgery. 218 13


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