scholarly journals EXTRAHEPATIC METABOLISM OF PROPOFOL IN MAN DURING THE ANHEPATIC PHASE OF ORTHOTOPIC LIVER TRANSPLANTATION †

1992 ◽  
Vol 68 (2) ◽  
pp. 183-186 ◽  
Author(s):  
P. VEROLI ◽  
B. O'KELLY ◽  
F. BERTRAND ◽  
J.H. TROUVIN ◽  
R. FARINOTTI ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Extrahepatic Metabolism ◽  
Anhepatic Phase

Extrahepatic Metabolism of Sevoflurane in Children Undergoing Orthotopic Liver Transplantation

2000 ◽  
Vol 92 (3) ◽  
pp. 683-686 ◽  
Author(s):  
Luc J. Van Obbergh ◽  
Roger K. Verbeeck ◽  
Ives Michel ◽  
Serene Lim ◽  
Francis Veyckemans
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Orthotopic Liver Transplantation ◽  
Fluoride Concentration ◽  
Inorganic Fluoride ◽  
End Stage Liver Disease ◽  
Arterial Blood ◽  
Extrahepatic Metabolism ◽  
Anhepatic Phase ◽  
End Stage

Background Sevoflurane is metabolized by cytochrome P450 and produces inorganic fluoride. The anhepatic phase of liver transplantation provides a useful tool to study the extrahepatic metabolism of drugs. The authors therefore studied the extrahepatic metabolism of sevoflurane by measuring the fluoride production in children receiving sevoflurane solely during the anhepatic phase of orthotopic liver transplantation. Methods Children with end-stage liver disease undergoing orthotopic liver transplantation were studied. Anesthesia was provided with isoflurane, sufentanil, and pancuronium. In one group, isoflurane was replaced by sevoflurane as soon as the liver was removed from the patient and maintained until reperfusion of the new liver. Arterial blood samples were drawn at induction, before removal of the liver, 15 min and 30 min after the beginning of the anhepatic phase, at the unclamping of the new liver, and finally 60 and 120 min after the unclamping. Plasma fluoride concentrations were determined by ion-selective electrode. Results No differences between the two groups (n = 10) regarding age, weight, duration of the anhepatic phase, or basal level of inorganic fluoride were found. The fluoride concentration increased significantly as soon as sevoflurane was introduced; it remained stable in the group receiving isoflurane. The peak fluoride concentration was also significantly higher in the first group (mean +/- SD: 5.5 +/- 0.8 microM (sevoflurane group) versus 1.4 +/- 0.5 microM (isoflurane group) P < 0.05). Conclusions These results demonstrate the existence of an extrahepatic metabolism of sevoflurane at least in children with end-stage liver disease.

Evolution of Urokinase-Type Plasminogen Activator (u-PA) and Tissue-Type Plasminogen Activator (t-PA) in Orthotopic Liver Transplantation (OLT)

1993 ◽  
Vol 69 (01) ◽  
pp. 056-059 ◽  
Author(s):  
G Himmelreich ◽  
G Dooijewaard ◽  
P Breinl ◽  
W O Bechstein ◽  
P Neuhaus ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Plasminogen Activator ◽  
Orthotopic Liver Transplantation ◽  
Tissue Type ◽  
Bleeding Complications ◽  
Activity Levels ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Urokinase Type Plasminogen Activator ◽  
Anhepatic Phase

SummaryIn orthotopic liver transplantation (OLT) hyperfibrinolysis seems to be of causative importance for intra- and postoperative bleeding. Although recently hyperfibrinolysis has been successfully reduced by intraoperative aprotinin treatment, small increases of fibrinolysis still remain during OLT. Originally, tissue-type plasminogen activator (t-PA) was considered to be responsible for the increases, but the efficacy of aprotinin which inhibits besides plasmin also kallikrein and urokinase-type plasminogen activator (u-PA) suggested also a role for the intrinsic and contact system-dependent plasminogen activators. We investigated the role of u-PA. From 29 patients undergoing OLT with intraoperative aprotinin infusion arterial blood samples were taken at 7 different time points. The preoperative median values for u-PA antigen (u-PA Ag) and plasmin-activatable single-chain u-PA (scu-PA) levels, which were more than 2-fold above normal (both: p <0.01), decreased slightly during the preanhepatic phase and remained unchanged during the anhepatic phase. With reperfusion of the graft liver the two levels decreased significantly (p = 0.0003 and p = 0.006, respectively) to almost normal values, probably due to clearance by the graft liver. Active two-chain u-PA (tcu-PA) was preoperatively 2-fold above the detection limit, remained stable during the preanhepatic phase and increased 2-fold in the anhepatic phase (p = 0.0018). As expected tcu-PA also relapsed upon reperfusion, but to the preoperatively enhanced level, possibly caused by sustained activation of scu-PA by cathepsin B. t-PA activity levels were at the upper end of the normal range preoperatively, slightly increased during preanhepatic and anhepatic phases and decreased significantly with reperfusion. The increases in tcu-PA and t-PA activities during the anhepatic phase coincided with greatly increased fibrinolysis as demonstrated by thrombelastography, indicating that both u-PA and t-PA are involved in the development of fibrinolysis during OLT.One patient was excluded from statistical evaluations because preoperative u-PA Ag, scu-PA, tcu-PA and t-PA activity levels were much higher than in the other 28 patients. In the investigated group this patient was the only one with diffuse peritonitis intraoperatively and severe bleeding complications postoperatively which made retransplantation mandatory.

scholarly journals A.283 Pulmonary metabolism of propofol in pigs during anhepatic phase of orthotopic liver transplantation

1996 ◽  
Vol 76 ◽  
pp. 89
Author(s):  
Zeynep Eti ◽  
Tümay Umuroglu ◽  
Abdurrahman Yayci ◽  
Serpil Ustalar ◽  
F. Yilmaz Gögüç
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Anhepatic Phase

scholarly journals Hemodynamics alterations during orthotopic liver experimental transplantation in pigs

2008 ◽  
Vol 23 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Orlando Jorge Martins Torres ◽  
Patrícia Brandão Pantoja ◽  
Erica Sampaio Barbosa ◽  
Cristiany de Almeida Barros ◽  
Elizabeth Teixeira Noguera Servin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Venous Pressure ◽  
Systemic Arterial Pressure ◽  
Blood Gas ◽  
Cold Ischemia ◽  
Central Venous ◽  
Anhepatic Phase ◽  
The Mean

PURPOSE: To describe the hemodynamics alterations during orthotopic liver transplantation in pigs. METHODS: In the period from April 2004 to December 2005, forty-four female Landrace pigs, weighting between 32 and 38 Kg were undergone to orthotopic liver transplantation. The animals were divided into two groups, donor and recipient pairs, which received whole liver grafts. The surgical procedure was divided into four parts: harvested, back-table, hepatectomy of the recipient and implantation. We analyze heart rate, blood gas, mean systemic arterial pressure (MAP-mmHg), central venous pressure, pH, Na-, K+, Cl-, Ca+ and urinary output. RESULTS: The mean anhepatic time was 69 min, cold ischemia was 252.2 min and back-table was 56.6 min. Blood pressure and heart rate dropped significantly during anhepatic phase and after revascularization. Blood gas and electrolytes alterations were observed during anhepatic and reperfusion phases. Although alterations were noted during these phases, the hemodynamic status was recovered and stabilized in the end of the surgery. CONCLUSIONS: Simplified technique of liver transplant was achieved and description of hemodynamic alterations was possible in pigs.

Plasma Concentrations of Laudanosine, but Not of Atracurium, Are Increased during the Anhepatic Phase of Orthotopic Liver Transplantation in Pigs

1990 ◽  
Vol 72 (1) ◽  
pp. 145-152 ◽  
Author(s):  
Jean-François Pittet ◽  
Edömer Tassonyi ◽  
Corinne Schopfer ◽  
Denis R. Morel ◽  
Gilles Mentha ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Plasma Concentrations ◽  
Anhepatic Phase

Supraceliac aortic clamping during the anhepatic phase of experimental orthotopic liver transplantation

1999 ◽  
Vol 34 (9) ◽  
pp. 1374-1377 ◽  
Author(s):  
M. López-Santamaria ◽  
L. Migliazza ◽  
M. Gamez ◽  
J. Murcia ◽  
J.A. Paz Cruz ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Aortic Clamping ◽  
Anhepatic Phase

Interest of BIS monitoring to guide propofol infusion during the anhepatic phase of orthotopic liver transplantation

2008 ◽  
Vol 27 (12) ◽  
pp. 975-978 ◽  
Author(s):  
L. Tremelot ◽  
A. Restoux ◽  
C. Paugam-Burtz ◽  
S. Dahmani ◽  
L. Massias ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Anhepatic Phase
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