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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 53-year-old man with alpha-1-antitrypsin deficiency had an 8-year history of progressive dyspnoea and two episodes of bleeding oesophageal varices with liver decompensation. After the diagnosis of terminal pulmonary emphysema (Fig. 1) and liver cirrhosis with progressive liver failure was made, he was accepted for combined lung and liver transplantation. METHODS. Anaesthesia was induced with thiopentone and fentanyl and maintained with fentanyl, midazolam, and isoflurane. After relaxation with succinylcholine, the patient's trachea was intubated with a left endobronchial double-lumen tube. Haemodynamic monitoring included arterial, central-venous, pulmonary-artery, and capillary-wedge pressures and cardiac output measurement. Ventilatory monitoring consisted of pulse oximetry, side-stream spirometry, and continuous measurement of arterial and mixed-venous blood oxygen saturation with fibreoptic catheters. A left single-lung transplantation was performed under one-lung ventilation without cardiopulmonary bypass. Prostacyclin was infused to reduce pulmonary vascular resistance. The transplant was ventilated separately with 50% oxygen and positive end-expiratory pressure of 8-10 cm H2O, and then liver transplantation was carried out. The institution of veno-venous bypass during the anhepatic phase failed because of portal-vein and axillary-vein thrombi. RESULTS. Total operation time was 6 h 30 min. Clamping of the left pulmonary artery lasted 45 min and the duration of the anhepatic phase was 92 min. Ventilation and oxygenation during lung transplantation caused no problems (Table 1). Clamping of the left pulmonary artery caused a slight increase in pulmonary vascular resistance (104 to 124 dyn.s.cm-5) and mean pulmonary artery pressure (25 to 27 mm Hg) without a decrease in cardiac index (Table 2). During the anhepatic phase with exclusion of the portal vein and inferior vena cava, a marked decrease in cardiac index (-27.2%) was seen (Table 4). The operation required substitution with 10 units packed red blood cells, 12 units fresh frozen plasma, and 5 platelet concentrates. The post-operative course showed normal liver graft function (Table 5). Acute pulmonary rejection on the 7th day was treated successfully with methylprednisolone. The patient's trachea has extubated 10 days after transplantation and he was discharged from the intensive care unit 2 weeks later. CONCLUSION. The management of this combined lung and liver transplantation was performed according to the experience with isolated lung and liver transplants in our hospital. Aggressive haemodynamic and ventilatory monitoring, including systemic and pulmonary arterial fibreoptic catheters, seems of particular importance in such high-risk procedures.
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PMID:[Combined lung and liver transplantation. Anesthesiologic management]. 804 61

The prevention and therapy of upper digestive hemorrhage due to rupture of esophageal varices in patients with liver cirrhosis are not yet effective enough. For their improvement, a transjugular intrahepatic portosystemic shunt (TIPS) is achieved by a new method which, without requiring general anesthesia, creates a shunt between a portal vein branch and the inferior vena cava. The indications, contraindications, outcome and eventual accidents of TIPS are analysed in the light of the latest data in the medical literature.
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PMID:Transjugular intrahepatic portosystemic shunt. 808 9

The authors present and discuss the care of a nine-month-old with neonatal adrenoleukodystrophy who required general anaesthesia for gastrointestinal endoscopy. Neonatal adrenoleukodystrophy is an inherited disorder of peroxisomal enzymes. Anaesthetic care may be affected by the presence of hypotonia, liver function abnormalities, gastroesophageal reflux, and impaired adrenocortical function. Preoperative sedation is contraindicated because of the risk of precipitating airway obstruction due to pre-existing hypotonia. Anaesthetic induction and tracheal intubation should be performed to minimize the risk for aspiration of gastric contents. The choice of muscle relaxant should take into account the pre-existing hypotonia as well as the possibility of hyperkalaemia in response to succinylcholine. Anaesthetic agents known to decrease the seizure threshold should be avoided in patients with a seizure disorder. In addition, anaesthetic agents that rely on the liver for metabolism should be used with caution in patients with cirrhosis. When time permits, these patients should be screened for adrenocortical insufficiency before surgery, and perioperative steroid coverage is advisable when preoperative testing of adrenocortical function is not feasible. While these patients eventually die after progressive deterioration, full recovery from the effects of anaesthesia and surgery can be achieved with attention to neurological, metabolic, and physical problems.
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PMID:Anaesthesia for the patient with neonatal adrenoleukodystrophy. 811 45

Ten healthy patients and 25 patients with cirrhosis of the liver (10 Child's A, 10 Child's B and 5 Child's C) received a bolus dose of mivacurium chloride 150 micrograms kg-1. The electromyographic response was monitored throughout anaesthesia until recovery of the first twitch of the train-of-four (TOF) (T1/T0) to at least 85% and the TOF ratio (T4:T1) to at least 80%. There was no significant difference between the two groups in the onset of neuromuscular block, but recovery was prolonged in the cirrhotic group compared with the healthy patients (respective mean times to recovery of T1/T0: to 5% = 20.2 vs 11.2 min (P < 0.05); to 10% = 23.8 vs 13.4 min (P < 0.005); to 25% = 28.4 vs 16.6 min (P < 0.005); to 50% = 41.1 vs 20.1 min (P < 0.005); to 75% = 43.8 vs 24.9 min (P < 0.005). Recovery of T4:T1 to 70% = 48.1 vs 27.4 min (P < 0.005)). Recovery was most prolonged in the Child's C patients. Mean plasma cholinesterase activity was less in the cirrhotic compared with the healthy group (mean 582 (SD 254) iu litre-1 vs 1125 (303) iu litre-1) (P < 0.001) and there was a significant negative correlation between plasma cholinesterase activity and all the indices of recovery (P < 0.001 for all except recovery index (P < 0.01)). We conclude that patients with hepatic cirrhosis may be sensitive to mivacurium, which could be explained, at least in part, by the lesser plasma cholinesterase activity.
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PMID:Pharmacodynamics of mivacurium chloride in patients with hepatic cirrhosis. 812 97

Systemic and splanchnic hemodynamics in experimental liver cirrhosis in rats induced by thioacetamide were evaluated by the radioactive microsphere method. Cardiac output and regional blood flow were measured in conscious and anesthetized control and cirrhotic rats. The conscious thioacetamide-treated rats had hyperdynamic circulation with an increased cardiac index (300 +/- 10 vs 258 +/- 3 ml/min/kg body weight, P < 0.001) and increased portal venous inflow compared with the controls (64.60 +/- 2.4 vs 48.39 +/- 0.88 ml/min/kg body weight, P < 0.001). Under pentobarbital anesthesia, the hyperdynamic circulation of the cirrhotic rats was maintained, with an increased cardiac index (276 +/- 7 vs 229 +/- 5 ml/min/kg body weight, P < 0.001) and increased protal venous inflow compared with the controls (72.47 +/- 3.0 vs 54.08 +/- 1.2 ml/min/kg body weight, P < 0.001). Portal pressure, portal venous resistance, and portal systemic shunting increased significantly while splanchnic arterial resistance decreased significantly in cirrhotic rats. Thioacetamide-induced cirrhosis is a useful model for the hemodynamic study of portal hypertension and remains useful in hemodynamic studies in the basal state under pentobarbital anesthesia.
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PMID:Hemodynamic characterization in experimental liver cirrhosis induced by thioacetamide administration. 826 20

Hepatic regeneration of cirrhotic liver following partial hepatectomy was evaluated in the rats following portal triad cross clamp (Pringle's maneuver). Cirrhotic rats were induced by repeated intraperitoneal injection of thioacetamide. Sixty eight percent of partial hepatectomy was performed under general anesthesia with or without total hepatic normothermic ischemia. Pringle's maneuver consisted of 4 times repetition of the combination of 15-minute ischemia and 15-minute reperfusion. Rats were sacrificed on 1, 7, and 28 postoperative days. The increasing rate of regenerated liver, the labeling index (LI) by histochemical measurement of BrdU positive hepatocyte, biochemical tests of the blood were evaluated in non cirrhotic and cirrhotic rats. Cirrhotic rats tolerated Pringle's maneuver well, without portal congestion as observed in non cirrhotic rats, suggesting the formation of porto-systemic shunt in cirrhotic rats. The inhibition in DNA synthesis and hepatic regeneration rate was observed in liver cirrhosis. However, no statistical significant difference in hepatic regeneration was observed in cirrhotic rats with or without Pringle's maneuver. In conclusion, the rat with cirrhotic liver tolerated Pringle's maneuver well and the maneuver itself was not harmful for hepatic regeneration following the partial resection.
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PMID:[Effect of ischemia and reperfusion on hepatic regeneration following partial hepatectomy in cirrhotic rat liver]. 831 1

Whereas portal systemic shunts pose significant problems in many patients, they have long been thought to have particular risks when undertaken in older cirrhotic patients, with devastating encephalopathy reportedly common in older patients undergoing nonselective shunt surgery. With advances in anesthesia management and perioperative monitoring and the advent of selective shunting, we postulated that both the operative and long-term outcomes might be improved. In this context, we reviewed our recent experience with selective shunts [distal splenorenal (DSRS) and small-diameter interposition portacaval grafts (IPCG)] in patients over the age of 60 years with variceal bleeding. Nineteen consecutive cirrhotic patients over 60 years of age undergoing elective or urgent selective shunt surgery for variceal hemorrhage since 1986 were identified. Sixteen patients underwent DSRS, and 3 underwent IPCG. The etiologies of the cirrhosis were multiple, with 12 of 19 classified as Child's B or C disease. There were no operative deaths, and all but one patient returned home following the surgery. No patient has had recurrent bleeding or required further surgery for portal hypertension-related problems. Three of 19 developed encephalopathy, and 4 of 19 died of liver failure within 1 year of surgery. Of the 14 patients still alive and well (mean postoperative survival: 44 months, range: 4 to 74 months), all remain free of encephalopathy and live independently. Based on this experience, it would appear that one can anticipate satisfactory short- and long-term outcomes after selective shunt surgery in selected patients with variceal bleeding over the age of 60 years. These patients with portal hypertension should not, therefore, be rejected for shunt surgery based on age alone.
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PMID:Selective shunts in selected older cirrhotic patients with variceal hemorrhage. 836 37

An acute transient swelling of the parotid glands is recorded after general anaesthesia in orthopaedic surgery. The first differential diagnosis is bacterial parotitis; other causes of gland enlargement are viral infections, lymphoma, leukemia, sarcoidosis, Sjogren's syndrome, malnutrition cirrhosis, vomiting, and poor oral hygiene. Excluding the above mentioned conditions, the most probably factors involved in our case are drugs used for anaesthesia, congestion of the venous drainage of the gland because of parasympathetic stimula during tracheal intubation and head positioning during surgery.
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PMID:[Transitory swelling of a parotid gland following general anesthesia. Description of a case]. 891 36

Central hemodynamics, aminotransferases, and alpha-fetoprotein were studied during surgery in 26 children with cirrhosis of the liver. In contrast to total intravenous anesthesia with preinjection of clofelin, in anesthesia with neuroleptanalgesia agents and N2O circulation hyperdynamia develops in the course of surgery, the process grows more active, and liver capacity to regeneration in the early postoperative period is depressed.
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PMID:[Features of anesthesia in surgery of liver cirrhosis in children]. 904 76

Gastroesophageal variceal hemorrhage is a rare complication during an operation. We present a case of gastric variceal re-rupture during an emergent operation for devascularization of the gastric veins. The patient was a 72-year old man with liver cirrhosis, who developed gastric variceal hemorrhage on the day of surgery. Sclerotherapy with an endoscope was performed, and the hemorrhage was controlled four hours before entering the operating theater. The induction of anesthesia and tracheal intubation were done with rapid sequence because the patient was regarded as full stomach. Induction was completed successfully. However, gastric varix ruptured immediately after the beginning of the surgery. The hemorrhage into the stomach amounted to 2,165 ml. The patient developed hypotension of 40 mmHg of systolic pressure for 15 minutes. With fluid resuscitation, continuous infusion of dopamine and ligation of varix, the patient recovered from this hypotensive event. No neurological deficit developed postoperatively. Portal hypertension results from increased resistance to portal venous blood flow or increased portal venous blood flow. Therefore, increased intravascular volume may play a significant role in precipitating variceal hemorrhage. In this case, abrupt circulatory change due to inadequate depth of anesthesia may partly cause massive hemorrhage. In conclusion, since potential adverse effects of increased blood volume and hepatic resistance on variceal hemorrhage must be considered during anesthesia, patients with episode of variceal hemorrhage should be treated as full stomach although endoscopic findings before the surgery indicate controlled hemorrhage from varix.
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PMID:[Intraoperative re-rupture of gastric varix immediately after the start of an operation in a patient with liver cirrhosis]. 925 19


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