| Hemodynamic Changes during the Pringle Maneuver in Patients with Abnormal Liver Function. |
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Soon Eun Park, Kyu Taek Choi, Kyu Sam Hwang, Mi Young Ahn, Kwang Min Park |
1Department of Anesthesiology, College of Medicine Ulsan University, Seoul, Korea.
2Department of General Surgery, College of Medicine Ulsan University, Seoul, Korea. |
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| Abstract |
BACKGROUND
During the Pringle maneuver (PM), the increase of systemic vascular resistance (SVR) and the active constriction of the intrahepatic capacitance vessels could minimize arterial blood pressure change. Pressor reactivity to sympathetic agonists is impaired and blood volume buffering capability is less efficient in a cirrhotic liver.
Accordingly, we evaluated the relations between hemodynamics during PM and preoperative liver function test (LFT) by serum aminotransferase and Indocyanine Green (ICG) clearance.
METHODS
Twenty-seven patients undergoing hepatectomy with PM were classified into two groups according to the liver function state assigned by serum aminotransferases and ICG clearance test. Sequential changes of hemodynamics were measured with Doppler flowmeter during PM. Hemodynamic data were analyzed by using ANOVA for repeated measurement.
Correlation between LFTs were sought using Pearson correlation and logistic regression.
RESULTS
During the PM, cardiac output decreased significantly compared to the preclamping period in the abnormal LFT group. There were no significant changes in any other hemodynamic variables in the normal LFT group. When comparing the two groups during PM, mean arterial blood pressures and cardiac output were significantly lower in the abnormal LFT groups compared to the normal LFT groups (P< 0.05).
CONCLUSIONS
These differences may suggest that cardiovascular responsiveness to reflex autonomic stimulation during the PM is significantly impaired in patients with abnormal LFT compared with normal LFT subjects. |
| Key Words:
Liver, hepatic function; Monitoring, hemodynamics; Surgery, liver resection, pringle maneuver |
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