Perioperative liver protection

Beck, Christopher; Schwartges, Ingo; Picker, O.

doi:10.1097/mcc.0b013e328336ea83

Cited by 7 publications

(8 citation statements)

References 63 publications

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“…Mild liver dysfunction in patients without liver disease is common following major surgery ( 232 , 233 ). Acute “ischemic hepatitis,” as it is termed, is a diffuse injury that arises secondary to hypoperfusion (hemodynamic instability) and hypoxia, and is exacerbated by systemic inflammation.…”

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

“…More serious complications can arise in patients with preexisting liver disease and cardiac dysfunction. The liver is particularly vulnerable to low flow because of its high O 2 requirement and complex portal vein and hepatic artery network ( 38 , 232 , 234 ). The portal system from the stomach, spleen, pancreas, intestines, and omentum supplies 70–80% of blood to the liver at very low pressures (5–10 mmHg) ( 234 ), and patients with chronic hepatic congestion or cirrhosis are vulnerable to hypoxic liver injury ( 232 ).…”

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

“…The liver is particularly vulnerable to low flow because of its high O 2 requirement and complex portal vein and hepatic artery network ( 38 , 232 , 234 ). The portal system from the stomach, spleen, pancreas, intestines, and omentum supplies 70–80% of blood to the liver at very low pressures (5–10 mmHg) ( 234 ), and patients with chronic hepatic congestion or cirrhosis are vulnerable to hypoxic liver injury ( 232 ). Other risk factors include the use of CPB, total time on bypass, non-pulsatile flows, fluid overload, and the type of anesthetic and perioperative vasopressor support ( 233 ).…”

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

“…As mentioned above (see Gastrointestinal Injury and the “Cytokine Storm” ), CPB can lead to decreases in splanchnic blood flow by ~20% and hepatic arterial blood flow by up to 45% ( 222 ), which may lower venous return and therefore CO resulting in systemic ischemia ( 38 , 235 ). Anesthetic agents can also reduce hepatic artery blood flow by 50–70% ( 232 , 233 ). Agents such as isoflurane, desflurane, sevoflurane, and propofol are preferred in patients with liver disease because they have less impact to reduce blood flow compared to other inhaled anesthetic agents ( 232 , 233 ).…”

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

“…Anesthetic agents can also reduce hepatic artery blood flow by 50–70% ( 232 , 233 ). Agents such as isoflurane, desflurane, sevoflurane, and propofol are preferred in patients with liver disease because they have less impact to reduce blood flow compared to other inhaled anesthetic agents ( 232 , 233 ).…”

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

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Addressing the Global Burden of Trauma in Major Surgery

Dobson

2015

Front. Surg.

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Despite a technically perfect procedure, surgical stress can determine the success or failure of an operation. Surgical trauma is often referred to as the “neglected step-child” of global health in terms of patient numbers, mortality, morbidity, and costs. A staggering 234 million major surgeries are performed every year, and depending upon country and institution, up to 4% of patients will die before leaving hospital, up to 15% will have serious post-operative morbidity, and 5–15% will be readmitted within 30 days. These percentages equate to around 1000 deaths and 4000 major complications every hour, and it has been estimated that 50% may be preventable. New frontline drugs are urgently required to make major surgery safer for the patient and more predictable for the surgeon. We review the basic physiology of the stress response from neuroendocrine to genomic systems, and discuss the paucity of clinical data supporting the use of statins, beta-adrenergic blockers and calcium-channel blockers. Since cardiac-related complications are the most common, particularly in the elderly, a key strategy would be to improve ventricular-arterial coupling to safeguard the endothelium and maintain tissue oxygenation. Reduced O2 supply is associated with glycocalyx shedding, decreased endothelial barrier function, fluid leakage, inflammation, and coagulopathy. A healthy endothelium may prevent these “secondary hit” complications, including possibly immunosuppression. Thus, the four pillars of whole body resynchronization during surgical trauma, and targets for new therapies, are: (1) the CNS, (2) the heart, (3) arterial supply and venous return functions, and (4) the endothelium. This is termed the Central-Cardio-Vascular-Endothelium (CCVE) coupling hypothesis. Since similar sterile injury cascades exist in critical illness, accidental trauma, hemorrhage, cardiac arrest, infection and burns, new drugs that improve CCVE coupling may find wide utility in civilian and military medicine.

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Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

Section: Effects Of Major Surgery On the Other Organsmentioning

confidence: 99%

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Addressing the Global Burden of Trauma in Major Surgery

Dobson

2015

Front. Surg.

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Cohort Multicenter Study on the Role of Medications in Parenteral Nutrition–Related Alteration of Liver Function Tests in Adults

Antonio

Miana‐Mena

Martínez‐Bernabé³

et al. 2020

J Parenter Enteral Nutr

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Background Our objective was to assess in non–critically‐ill adult inpatients receiving parenteral nutrition (PN) the risk of developing liver function test (LFT) alterations when receiving concomitant possibly hepatotoxic medications or others reported to improve LFTs during PN. Methods A multicenter retrospective analysis of prospectively collected data was performed on patients receiving PN. Two groups were recruited: group LALT (patients with any LFT alterations during PN), and group NOLALT (patients without such alterations). Exclusion criteria were previous sepsis, shock, renal failure, hyperglycemia, LFT alteration, or biliopancreatic surgical procedures. Medications were classified into 2 categories: medications reported to improve LFTs during PN (n = 8) and possibly hepatotoxic medications (n = 54), including a subgroup of possibly highly hepatotoxic medications (n = 30). Results The study included 200 patients, 136 (68.0%) in the LALT group. The groups differed in the number of patients requiring surgical intervention ≤7 days before PN (LALT, 94 [69.1%]; NOLALT, 29 [45.3%]; P < .002) and those receiving possibly hepatotoxic medications (LALT, 126 [92.6%]; NOLALT, 45 [70.3%]; P < .001). Variables in the final Cox regression model were possibly hepatotoxic medications, odds ratio (OR) 3.310 (1.678–6.530); surgical intervention prior to PN, OR 1.861 (1.277–2.711); baseline triglyceridemia, OR 1.005 (1.001–1.009); and creatinine, OR 1.861 (1.043–3.323). Conclusions Patients who received PN and concomitantly possibly hepatotoxic medications had a 3‐fold risk of developing LFT alterations. Medications reported to improve LFTs had no effect. The use of possibly hepatotoxic medications during PN was associated with LFT alterations.

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Complications of Liver Surgery

Panzer

Sandadi

2012

Liver Anesthesiology and Critical Care Medicine

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Perioperative liver protection

Cited by 7 publications

References 63 publications

Addressing the Global Burden of Trauma in Major Surgery

Addressing the Global Burden of Trauma in Major Surgery

Cohort Multicenter Study on the Role of Medications in Parenteral Nutrition–Related Alteration of Liver Function Tests in Adults

Complications of Liver Surgery

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