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)

For 5 years (1976-1981) peritoneovenous shunting has been used in 32 patients with intractable ascites--that is, in patients in whom medical therapy has failed. All operations but one were performed using local anesthesia. The LeVeen shunt was used in 29 patients and the Denver shunt in three patients. Good palliation was achieved in 14 of 23 patients with ascites due to liver cirrhosis. Seven out of eight patients with tense ascites secondary to malignancy were relieved. Complications were seen in six patients. In one patient severe disseminated intravascular coagulopathy made removal of the shunt necessary. Leakage, local infection, and skin necrosis, when present, could successfully be treated without removing the shunt. The surgical procedure is simple and offers relief to most patients with tense ascites resistant to medical therapy.
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PMID:Peritoneovenous shunting for intractable ascites. 716 35

Fentanyl kinetics were studied in patients with cirrhosis and in patients with normal hepatic and renal function undergoing surgery under general anaesthesia, the latter group served as the controls. Plasma fentanyl concentrations declined bi-exponentially in the controls with an average elimination half-life (T1/2 beta) of 263 min; total plasma clearance (Cl) as 10.8 ml min-1 kg-1, and total apparent volume of distribution (V beta) 3.81 litre kg-1. No significant change was observed in patients with cirrhosis: T1/2 beta was 304 min, Cl 11.3 ml min-1 kg-1 and V beta 4.41 litre kg-1. These data suggest that the elimination half-life of fentanyl is not primarily influenced by the rate at which it is metabolized in the liver.
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PMID:Fentanyl pharmacokinetics in anaesthetized patients with cirrhosis. 717 14

Thioacetamide (TAA) causes experimental liver cirrhosis in rats. TAA was administered (50 mg per kg body weight i.p. daily) to sham-operated and shunted rats for eight weeks. Then in pentobarbital anesthesia, bile flow and the maximal biliary excretion (Tm) of BSP were measured using constant infusion technique. Compared to the controls, BSP Tm values decreased significantly in cirrhotic rats. The change results from the lower concentration of dye. In cirrhotic animals the liver cannot excrete the dye per net fluid volume as efficiently, as in the controls. In animals having portocaval shunts and liver cirrhosis, a further decrease of dye excretion can be observed, indicating that the operation has some influence on the canalicular excretion of certain organic anions.
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PMID:The effect of portocaval shunt on bile flow and maximal biliary excretion of bromsulfophthalein sodium (BSP) in rats with thioacetamide induced liver cirrhosis. 723 17

Impairment of cerebral blood flow (CBF) autoregulation may have serious implications for patients with cirrhosis if arterial hypotension occurs during coma, anesthesia, bleeding, or sepsis. In this study, CBF autoregulation was investigated in patients with cirrhosis with no or mild encephalopathy. Ten patients (median age, 45 years; range, 30 to 61 years) and six healthy volunteers (median age, 30 years; range 21 to 61 years) were included. Catheters were placed in a radial artery and in the internal jugular veins. Baseline CBF was measured using single-photon emission computed tomography (SPECT) with concomitant measurements of cerebral arteriovenous oxygen content differences (AVDO2). CBF autoregulation was evaluated using the AVDO2 method and changes in mean flow velocity in the middle cerebral artery (Vmean) as determined by transcranial Doppler (TCD). Mean arterial pressure (MAP) was increased by 30 mm Hg by intravenous norepinephrine, and subsequently decreased by a combination of lower body negative pressure and ganglion blockade, whereas AVDO2 and Vmean were measured at each 5 mm Hg change in MAP. CBF was 61 (range, 45 to 78) mL 100 g-1 min-1 in patients with cirrhosis and 65 (range < 53 to 88) mL 100 g-1 min-1 in volunteers (not significant [NS]). There were no regional differences in CBF between the two groups. Arterial carbon dioxide tension was 31 (23 to 35) mm Hg in patients with cirrhosis and lower, compared with 36 (range, 34 to 47) mm Hg in the volunteers (P < .01). For evaluation of autoregulation, MAP was raised to 116 (range, 100 to 145) and then decreased to 39 (range, 34 to 50) mm Hg.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cerebral blood flow autoregulation and transcranial Doppler sonography in patients with cirrhosis. 765 76

We successfully anesthetized a 53-year-old female with hypercitrullinemia and severe liver cirrhosis. The hypercitrullinemia was accompanied with chronic hepatic encephalopathy due to hyperammonemia, which resulted from decreased activity of one of the urea cycle enzymes, argininosuccinate synthetase (ASS). She was scheduled for replacement arthroplasty of a fractured femoral neck. She suffered a consciousness disturbance due to hyperammonemia, which was successfully treated by oral administration of sodium benzoate before surgery. Spinal anesthesia was chosen because it would have the minimum metabolic load on the cirrhotic liver. During the operation, prostaglandin was continuously infused to maintain hepatic blood flow. Acetated Ringer solution was infused instead of lactated Ringer solution to reduce metabolic load on the liver. She was given a small dose each of fentanyl and midazolam for relief of pain and sedation. After the operation, naloxone and flumazenil were administered to antagonize the fentanyl and midazolam, respectively. Although the serum ammonia level temporarily increased during a postoperative interruption of oral administration of sodium benzoate, the patient did not develop loss of consciousness, which is a key sign of hyperammonemia. Surgery and anesthesia were uneventfully completed.
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PMID:[Anesthetic management for a patient with citrullinemia and liver cirrhosis]. 769 32

We have studied the pharmokinetics of cis-trans, trans-trans and cis-cis mivacurium in 10 healthy subjects and 11 patients with mild or moderate hepatic cirrhosis, during nitrous oxide-oxygen-isoflurane anaesthesia. Mivacurium 15 micrograms kg-1 min-1 was infused for 10 min (total dose 0.15 mg kg-1) and the plasma concentration of the three isomers measured at regular intervals for 190 min. The electromyographic response to the drug was also measured. Compartmental analysis of the resulting isomer profiles was undertaken: one- and two-compartment models were fitted to derive clearance, volume of distribution and half-life. Clearance of the cis-trans and trans-trans isomers was reduced significantly in the cirrhotic compared with the healthy group: cis-trans (median (range)) 44 (15-121) ml kg-1 min-1 vs 95 (57-213) ml kg-1 min-1 (P < 0.05); trans-trans 32 (12-64) ml kg-1 min-1 vs 70 (34-101) ml kg-1 min-1 (P < 0.05). The difference in the clearance of the cis-cis isomer in the cirrhotic (4.2 (2.9-12.1) ml kg-1 min-1) compared with the healthy group (5.2 (2.9-8.9) ml kg-1 min-1) was not significant with this sample size. Clearance of each isomer correlated significantly with plasma cholinesterase activity: cis-trans r = 0.73, P < 0.001; trans-trans r = 0.69, P < 0.001; cis-cis r = 0.48, P < 0.05.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacokinetics of the three isomers of mivacurium and pharmacodynamics of the chiral mixture in hepatic cirrhosis. 782 89

No evidence of hepatoxicity has been demonstrated with propofol. Propofol can be used for anaesthesia in patients suffering from moderate cirrhosis of the liver. Liver blood flow is preserved. Propofol dosage must be titrated to each patient's needs. Data concerning the use of propofol in patients suffering from severe hepatic failure or cholestasis are lacking. Propofol dosage in chronic alcoholic patients without cirrhosis must be increased.
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PMID:[Diprivan and liver]. 787 26

Arterial oxygen tension (Pao2), carbon dioxide tension (PaCO2), and vital capacity were measured preoperatively and one day postoperatively in patients with chronic hepatic cirrhosis having elective oesophageal injection sclerotherapy under general anaesthesia. The results were compared with the same measurements made in patients with chronic cirrhosis anaesthetised and scheduled to have injection sclerotherapy under general anaesthesia but who, because of variceal obliteration, only had an oesophagogastroscopy. In the injected group PaO2 decreased by 9.3 (3.0) mm Hg (1.2 (0.4) kPa) (mean (SEM)) (p < 0.02) but in the controls did not change. The difference between the two groups was significant (p < 0.02). Vital capacity decreased by 0.39 (0.08) litres (BTPS) (p < 0.01) after injection sclerotherapy but in the controls did not change. Again the difference between the two groups was significant (p < 0.02). In the injected group there was a significant correlation between the change in PaO2 and the percentage change in vital capacity (r = 0.787, p < 0.01) but no such relation was seen in control subjects. These results suggest that oesophageal injection sclerotherapy is associated with a restrictive defect in respiratory function one day after the injection caused, possibly, by sclerosant embolising to the lung.
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PMID:Respiratory function after injection sclerotherapy of oesophageal varices. 795 5

Cocaine was the first drug to be used as a local anaesthetic. It was introduced into medicine in 1884 by Koller. Other drugs soon followed, for example, ethyl chloride spray, tropocaine, eugenol (oil of cloves) and Nupercaine. A wide range of uses for local anaesthetics soon developed and the term 'regional anaesthesia' was first used by Cushing in 1901 to describe pain relief by nerve blockade. Local anaesthetic drugs are water soluble salts of lipid soluble alkaloids. Each molecule is composed of an aromatic portion, intermediate chain and an amide portion. The portions are joined by either amide or ester linkages. Ester-linked drugs are hydrolysed in the plasma by plasma cholinesterase and their half-life varies from one to eight minutes. Amide-linked drugs are degraded by oxidative dealkylation in the liver. The half-life of these drugs varies from 1.5 to more than three hours. The addition of a vasoconstrictor, such as adrenaline, will prolong the duration of action of both the amide- and ester-linked drugs. Degradation of the amide-linked drugs depends on factors such as hepatic blood flow and liver conditions, such as cirrhosis, and congestive cardiac failure. Anaphylactic reactions are more common with ester-linked drugs than amide-linked drugs. The drugs are usually available for injection as hydrochlorides in a salt solution with small amounts of fungicides or preservatives added to give stability.
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PMID:Local anaesthesia in the operating theatre. 799 96

A retrospective analysis was made of 58 patients who unexpectedly developed multiple organ failure (MOF) following elective surgery, and the results were compared with those of 168 control patients who did not develop MOF. In 33 patients with liver cirrhosis, MOF was related to poor liver function, a low albumin level, excessive blood loss, many transfusions, and a high incidence of hypotension. MOF, rather than liver failure alone, was featured by postoperative bleeding and infection. In 15 patients with esophageal carcinoma, MOF was correlated with many transfusions, anastomotic leakage, and postoperative infection. In 10 patients who underwent surgery for an aortic aneurysm, poor renal function and extended anesthesia time were associated with MOF. These results indicate that to prevent MOF following elective surgery, it is important to: (1) Select patients for liver surgery according to their liver function, and minimize the risk of bleeding and infection, (2) avoid too many blood transfusions, and minimize the risk of leakage and infection in esophageal surgery, and (3) select patients for aortic surgery based on renal function and reduce the anesthesia time as much as possible.
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PMID:A clinical analysis of multiple organ failure following elective surgery. 803 9


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