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)

We have compared the pharmacokinetics of propofol as an infusion in 10 control and 10 patients with cirrhosis. Anaesthesia was induced within 3-4 min during administration of an infusion of propofol 21 mg kg-1 h-1. After 5 min, the infusion was decreased in a stepwise manner to 12 mg kg-1 h-1 and subsequently 6 mg kg-1 h-1. The mean recovery time after discontinuation of the infusion was significantly longer in the cirrhotic group; however, when patients opened their eyes, blood concentrations of propofol were similar in both groups (1 micrograms ml-1). Pharmacokinetic analysis was performed from the beginning of infusion to 8 h after termination. Total body clearance was not reduced significantly in cirrhotic (1.56 (SD 0.48) litre min-1) compared with control (1.75 (0.32) litre min-1) patients. The volume of distribution at steady state was significantly greater in patients with cirrhosis than in control patients (202 (82) litre vs 121 (49) litre). However, this difference did not change terminal elimination half-life. The pharmacokinetics of propofol given by infusion to maintain general anaesthesia were not affected markedly by moderate cirrhosis.
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PMID:Pharmacokinetics of propofol infusions in patients with cirrhosis. 222 33

A case of a patient with severe liver dysfunction and hyperammonemia undergoing splenectomy and liver biopsy was reported. Preoperative examination revealed that this patient's liver function was severely impaired due to liver cirrhosis (ICG15 = 60%, HPT = 29%, serum NH3 = 110 micrograms.dl-1). Preoperatively, kanamycin 2 g.day-1 and lacturose 60 ml.day-1 were given and FFP 3-5 units.day-1 were infused. With no premedication, general anesthesia was induced with dTc 3 mg, thiopental 200 mg and SCC 80 mg. Anesthesia was maintained with N2O-O2-enflurane and pancuronium. Though N2O concentration was kept at 50% to prevent intraoperative hypoxemia, the necessary enflurane concentration was low (almost 1% or lower). Serum NH3 level during operation was stable (100-110 micrograms.dl-1), and the level decreased (66-90 micrograms.dl-1) postoperatively. Postoperatively, this patient's consciousness level fluctuated with or without flapping tremor. The treatment of hepatic encephalopathy with lactulose, aminoleban EN and maalox were effective. Problems of perioperative and anesthetic management of a patient for upper abdominal surgery with severe liver dysfunction associated with hyperammonemia were discussed.
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PMID:[Anesthetic experience of a patient for splenectomy with severe liver dysfunction and hyperammonemia]. 223 30

Evaluation of the surgical risk in cirrhotic patients undergoing emergency operations must take into account potential anesthesia-related problems, the specific type of operation, and altered liver function. Therefore, (a) the generic surgical risk, (b) the specific surgical risk and (c) the anesthetic risk, must be distinguished. The factors which affect the generic risk are the conditions which can worsen pre-existing liver failure (e.g. cardiopulmonary disease, area of surgical intervention, stage of liver cirrhosis). Splanchnic reflexes as well as lower venous return to the heart are the potential factors which may lead to reduced hepatic blood perfusion and, therefore, represent the specific surgical risk. The anesthetic risk is due to negative interference with the splanchnic circulation by both artificial ventilation and direct pharmacologic vasoconstrictor effects. Finally, the possibility that the patient is positive for HBV or HIV markers must be considered in order to carry out the necessary measures to avoid direct contact with the blood.
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PMID:[Surgical risks for cirrhotic patients]. 224 63

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. 226 5

The effects of ketamine, halothane, enflurane, and isoflurane on systemic and splanchnic hemodynamics in cirrhotic rats that were either normovolemic or hypovolemic following hemorrhage were characterized. Rats received at random either ketamine (30 mg/kg iv, 1.5 mg.kg-1.min-1 iv), halothane, enflurane, or isoflurane (1 MAC). Conscious rats were considered the control group. Four weeks before hemodynamic studies bile duct ligation was performed in all rats to induce cirrhosis. Hemodynamic measurements were performed using the radioactive microsphere method 1 h after the onset of anesthesia and 30 min after hemorrhage. Anesthetized rat lungs were mechanically ventilated with room air. Before hemorrhage cardiac index was higher in conscious rats and in rats receiving isoflurane than in the other groups (P less than 0.001). Hepatic arterial blood flow was similar in conscious rats and in those receiving isoflurane or halothane and was higher than in those receiving ketamine or enflurane. The lowest splanchnic and portal venous tributary blood flows were observed in rats receiving enflurane. After hemorrhage cardiac index was significantly less than before hemorrhage in all groups, except in rats receiving enflurane. After hemorrhage portal venous tributary blood flow decreased significantly in all groups except in enflurane group. During halothane and enflurane anesthesia hepatic arterial blood flow and hepatic arterial fraction of cardiac output decreased (P less than 0.01) and they were maintained in the other groups. After hemorrhage hepatic arterial fraction of cardiac output in conscious rats was higher than in those receiving ketamine, halothane, or enflurane (P less than 0.05) and was similar to those receiving isoflurane.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of ketamine, halothane, enflurane, and isoflurane on systemic and splanchnic hemodynamics in normovolemic and hypovolemic cirrhotic rats. 236 Jul 21

To evaluate the effect of liver cirrhosis on the pharmacokinetics and the pharmacodynamics of vecuronium, 12 patients with cirrhosis, aged (mean +/- SD) 52 +/- 12 yr, and 14 control patients, 42 +/- 15 yr, undergoing elective surgery under general anesthesia were studied. The simultaneous time courses of the plasma concentration of vecuronium and of the neuromuscular blockade were studied after the administration of a bolus dose of 0.2 mg X kg-1. Vecuronium plasma concentration declined biexponentially in both groups. Vecuronium plasma clearance was reduced significantly (P less than 0.01) from 4.26 +/- 1.38 ml X min-1 X kg-1 in the controls to 2.73 +/- 1.19 ml X min-1 X kg-1 in the patients with cirrhosis. The elimination half-life was 58 +/- 19 min in the controls and was prolonged significantly to 84 +/- 23 min (P less than 0.01) in the patients with cirrhosis. The total apparent volume of distribution was unchanged in patients with cirrhosis (0.253 +/- 0.086 1 X kg-1 vs. 0.246 +/- 0.092 1 X kg-1 in the controls). Cirrhosis caused a prolongation of the neuromuscular blockade induced by vecuronium: the duration of effect from injection to 50% recovery of the twitch height was prolonged by 100% (P less than 0.01) from 62 +/- 16 min in the controls to 130 +/- 52 min in patients with cirrhosis. The recovery rate (TH 25-75) also was prolonged (P less than 0.05) from 21 +/- 7 min in the controls to 44 +/- 18 min in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacokinetics and pharmacodynamics of vecuronium (ORG NC 45) in patients with cirrhosis. 285 15

The clinical neuromuscular effects of two doses of vecuronium (0.15 mg kg-1 and 0.2 mg kg-1) were investigated in 20 healthy patients and 20 patients with cirrhosis, and compared with previous work in which vecuronium 0.1 mg kg-1 was given under identical conditions of anaesthesia and monitoring. Ten healthy patients received vecuronium 0.15 mg kg-1 and 10 received 0.2 mg kg-1. Similarly, 10 patients with cirrhosis received vecuronium 0.15 mg kg-1 and 10 received 0.2 mg kg-1. Vecuronium 0.1 mg kg-1 has previously been shown to have a somewhat shorter duration of action in cirrhotic as opposed to healthy patients. In this study, vecuronium 0.15 mg kg-1 was found to have a similar duration of action in both groups, and vecuronium 0.2 mg kg-1 had a significantly longer action in the cirrhotic group. It is suggested that vecuronium should be used with caution in patients with hepatic dysfunction and that, in such patients, monitoring of neuromuscular function is desirable.
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PMID:The use of different doses of vecuronium in patients with liver dysfunction. 286 36

A rat model was used to determine whether isoflurane exacerbates liver dysfunction and whether its metabolism is changed in the presence of cirrhosis. Male Wistar rats were gavaged weekly with carbon tetrachloride until cirrhosis was well advanced. They and control rats without pretreatment with carbon tetrachloride and without cirrhosis were then exposed to 1.45% (1 MAC) isoflurane for 3 hours. Blood and urine samples were taken before, immediately, as well as 4, 24, 48, and 72 hours after anesthesia to measure liver function and isoflurane defluorination. After the last samples had been obtained, the rats were sacrificed and the liver removed for histologic examination and in vitro metabolic studies. Serum levels of SGOT and SGPT and inorganic fluoride production in rats with cirrhosis were similar to those in control rats without cirrhosis. Concentrations of cytochromes b5 and p-450 and specific activities of microsomal defluorinase and several cytosolic enzymes were significantly lower in cirrhotic than in noncirrhotic liver, but their total amounts in whole liver were the same. The results imply that cirrhosis does not increase the risk of acute hepatotoxicity of isoflurane. They also demonstrate that metabolism of isoflurane and perhaps other volatile anesthetics may be unaffected in rats with cirrhosis, even though liver architecture is severely disrupted.
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PMID:Hepatotoxicity and metabolism of isoflurane in rats with cirrhosis. 291 55

Retained or recurrent stones in the common bile duct remain a clinical problem in 2% to 5% of patients undergoing cholecystectomy. Nonoperative extraction via the T tube tract or endoscopic sphincterotomy is successful in 85% to 95% of patients; however, the remainder require reoperation. This study evaluates the efficacy of electrohydraulic shock wave lithotripsy therapy of common duct stones too large to be extracted endoscopically or by T tube. Six patients were entered into the study. Ages ranged from 62 to 93 years. All patients either had severe preexisting systemic disorders or were of an advanced age. Stones ranged in size from 10 to 41 mm, with a mean largest dimension of 22 mm. In all patients either extraction by traditional nonoperative means failed or there was a stone that was considered to be too large to be extracted successfully. Patients were treated with 1200 to 2400 shocks at 16 to 20 kV. Five of six patients were treated with local anesthesia and sedation. Stones were successfully fragmented in all but one patient. Five patients required extraction of the remaining fragments either through the T tube tract (one patient) or via endoscopic sphincterotomy. All patients were free of stones at discharge, with the exception of one patient with severe cirrhosis who had an intrahepatic stone behind a right hepatic duct stricture. This stone had been successfully fragmented but an endoscopic retrograde cholangio-pancreatogram revealed some residual fragments despite normal alkaline phosphatase and bilirubin values. There were no hospital deaths, although the patient with the intrahepatic stone died of bleeding varices several months later. Electrohydraulic shock wave lithotripsy seems to be an effective adjuvant treatment in clearing the bile duct of stones that would otherwise require reoperation.
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PMID:Electrohydraulic shock wave lithotripsy (ESWL) fragmentation of retained common duct stones. 317 59

Anaesthesia was provided by an infusion of propofol in six healthy patients and six patients with hepatic cirrhosis. There were no significant differences between the groups with regard to the central compartment volume, distribution volume at steady state, total apparent distribution volume, total body clearance or elimination half-life, although the values were always greater in the cirrhotic patients. Recovery times were significantly longer in the patients with cirrhosis.
Anaesthesia 1988 Mar
PMID:Pharmacokinetics of propofol administered by continuous infusion in patients with cirrhosis. Preliminary results. 325 91


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