Hemodynamic Changes during Isolated Liver Hemoperfusion of Hepatoma / 대한구급학회지

BACKGROUND: To analyze hemodynamic changes during single catheter technique of hepatic venous isolation and extracorporeal charcoal hemoperfusion for malignant liver tumor. METHODS: Drugs for chemotherapy were infused to the liver through hepatic artery. With 4-lumen- 2-balloon (4L-2B) catheter, hepatic venous blood was circulated to the extracorporeal charcoal system. During extracorporeal charcoal system circulation, drugs were eliminated and the blood was reinfused to supra-hepatic vein-IVC. At the same time, IVC was clamped. Systemic vascular resistance index (SVRI), cardiac index (CI), stroke volume index (SVI), mean arterial pressure (MAP), heart rate (HR) and arterial blood gas were measured after 4L-2B catheter insertion (T1), during test circulation (T2), after 20min chemotherapy (T3) and after 10min reperfusion (T4). RESULTS: MAP was decreased at T3 compared to T1 and increased at T4 compared to T3. CI was decreased at T3 and increased at T4 compared to T1. SVRI was decreased at T4 compared to T1. HR was increased at T2 and T3 compared to T1. SVI was decreased at T2 and T3 compared to T1. CONCLUSIONS: During clamping of IVC, MAP is decreased by decreased SVI in spite of increased HR. After IVC is released and the stagnated blood of lower extremity is recirculated, the MAP is returned to the value of after catheter insertion by increased SVI in spite of decreased SVRI.

Change of Plasma Xanthine Oxidase Activity by Intermittent Hepatic Ischemia-Reperfusion / 대한마취과학회지

BACKGROUND: The pringle maneuver (PM), hepatic inflow occlusion, during hepatic surgery reduces intraoperative bleeding and blood transfusion requirement, but hepatic ischemia/reperfusion injury is inevitable. During ischemia, xanthine oxidoreductase is converted to xanthine oxidase (XO), which can serve as a critical source of reactive oxygen species (reduces O2 to O2 .-) that contribute to inflammatory signaling, ischemia-reperfusion injury, and an impaired vascular function. The purpose of the present study was to follow changes of XO activity and O2 .- production during hepatic surgery under PM. METHODS: Eleven patients that underwent hepatectomy under intermittent PM were studied. Blood was withdrawn before PM, and 10 and 20 minutes after final reperfusion. Plasma XO activity was measured using a spectrophotometer after incubating plasma with/without xanthine for one-hour. Superoxide (O2 -) production was followed by measuring by cytochrome c reduction by plasma XO. RESULTS: After final reperfusion, plasma XO activity had increased four-fold (0.36 +/- 0.06 to 1.25 +/- 0.25 mU/ml) with a concomitant increase in O2 .- production (0.66 +/- 0.29 to 1.66 +/- 0.40microM/min). CONCLUSIONS: Significantly more XO is released into the systemic circulation after intermittent PM, with subsequently increased O2 .- production. The significant contribution of XO to hepatic surgery under PM might be beneficially managed using an anesthetic with a known antioxidative effect.