The Effects of Desflurane and Propofol on Portosystemic Pressure in Patients with Portal Hypertension

Mandell, M. Susan; Durham, Janette D.; Kumpe, David A.; Trotter, James F.; Everson, Gregory T.; Niemann, Claus U.

doi:10.1213/01.ane.0000090741.63156.1b

Cited by 28 publications

(16 citation statements)

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“…Some right heart catheterization information is derived from the operating room during the administration of general anesthesia 20. That pulmonary pressure tends to be higher during the initial stages of anesthesia than in the awake patient20 is not surprising, since inhalational anesthetic agents independently increase venous return and thus central filling and cardiac output in patients with portal hypertension 21…”

Section: Pphtnmentioning

confidence: 99%

Hepatopulmonary syndrome and portopulmonary hypertension in the model for end-stage liver disease (MELD) era

Mandell¹

2004

Liver Transpl

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Key Points 1. How do physicians decide which patients with pulmonary vascular disease will benefit from liver transplantation? 2. Studies on patients with pulmonary vascular disease are limited and the findings and recommendations may not apply to all practice sites. 3. All patients with hypoxemia, liver disease, and pulmonary vasodilation do not have hepatopulmonary syndrome (HPS). 4. Not all patients with hepatopulmonary syndrome will benefit from liver transplantation. 5. The mean pulmonary artery pressure (mPAP) may not be an accurate predictor of mortality in patients with portopulmonary hypertension. T he transplant community continues to expend considerable effort constructing organ allocation protocols that will reduce deaths on the transplant waiting list. However, the effects of hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN) on waiting list mortality and patient outcome are not fully understood. This creates a decisional dilemma as physicians try to determine if potential recipients with coexistent pulmonary vascular diseases should undergo transplantation and what priority they should be given for surgery. Because pulmonary vascular disease in transplant candidates is relatively rare, case reports and single institutional studies are the most common source of outcome data for these patients. The pressure to optimize organ allocation demands that investigators develop practice recommendations based upon this limited information. Thus, physicians question whether patient outcomes and recommendations from these studies are predictive in their own practices. HPSThe triad of liver disease, arterial deoxygenation while breathing room air and evidence of intrapulmonary vascular dilation defines HPS. 1 Although the pathophysiology of HPS is not well understood, it is clear that there is a causative relationship between hypoxemia due to HPS and liver disease. This relationship is the theoretic basis for suggesting liver transplantation could be an effective intervention. However, early results of transplantation in HPS patients were disappointing and reinforced opinions that HPS was of such significant risk to the patient and donor graft function that severe hypoxemia caused by HPS (partial pressure of arterial oxygen [PaO 2 ] Ͻ 50 mm Hg) should be considered as an absolute contraindication to liver transplantation. 2 Subsequent reports of improved survival following liver transplantation caused physicians to reconsider HPS as a contraindication and speculate that liver transplantation may be effective in reversing hypoxemia caused by HPS. This thinking persisted, culminating in recommendations that patients with hypoxemia due to HPS receive additional priority on the waiting list for liver transplantation. 3 Recent evidence that shows HPS independently increases morbidity and mortality in patients with cirrhosis waiting for transplantation adds support to current policies that recommend increasing transplant priority. 4 However, markedly different estimates in the prevalence of disea...

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Section: Pphtnmentioning

confidence: 99%

Hepatopulmonary syndrome and portopulmonary hypertension in the model for end-stage liver disease (MELD) era

Mandell¹

2004

Liver Transpl

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“…While in the medical ICU spontaneous bacterial peritonitis and (sub)acute gastrointestinal bleeding represent the typical problems giving rise to deterioration of hepatocellular function in patients with end-stage liver disease [5,6]. The surgical patient with pre-existing liver disease is endangered by loss of hepatocellular mass, for example due to liver resection (as in the case of surgery for hepatocellular carcinoma in chronic hepatitis), perioperative impairment of liver perfusion as a result of surgery, and/or anesthesia as well as septic complications [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Liver failure

Bauer

Winning

Kortgen

2005

Current Opinion in Anaesthesiology

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“…It is also known that volatile anesthetics agents cause dose-related alteration of active and passive mechanical properties of the left atrium; depressing contractility, delaying relaxation, enhancing the reservoir function, and altogether impairing atrial/ventricular coupling (17,18). In fact, desflurane anesthesia could decrease total hepatic blood flow (19,20). We would, therefore, suggest that because advanced liver cirrhosis is associated with a dysregulated splanchnic vasodilation and portosystemic shunts, the activation of neurohumoral response will be impaired under general anesthesia, leading to poor nitric oxide and adenosine regional protective role.…”

Section: Discussionmentioning

confidence: 99%

Lack of Correlation Between Preoperative and Intraoperative Liver Hemodynamics

et al. 2014

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The Effects of Desflurane and Propofol on Portosystemic Pressure in Patients with Portal Hypertension

Abstract: Desflurane reduces the blood pressure difference between the portal and systemic circulations. This can cause errors in assessment of the success of medical therapy of portal hypertension. Propofol has less effect on the difference between the portal and systemic circulation.

Cited by 28 publications

References 28 publications

Hepatopulmonary syndrome and portopulmonary hypertension in the model for end-stage liver disease (MELD) era

Hepatopulmonary syndrome and portopulmonary hypertension in the model for end-stage liver disease (MELD) era

Liver failure

Lack of Correlation Between Preoperative and Intraoperative Liver Hemodynamics

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