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Cerebral blood flow and metabolism in patients with chronic liver disease undergoing orthotopic liver transplantation
Author(s) -
Philips Barbara J.,
Armstrong Ian R.,
Pollock Anthony,
Lee Alistair
Publication year - 1998
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510270209
Subject(s) - liver transplantation , cerebral blood flow , medicine , encephalopathy , transplantation , cirrhosis , anesthesia , hemodynamics , hepatic encephalopathy , chronic liver disease , cardiology
Changes in cerebral hemodynamics and metabolism associated with anesthesia and liver transplantation may present particular hazards for patients with cirrhosis. Fifteen patients undergoing liver transplantation were studied, 7 of whom had encephalopathy. Cerebral blood flow (CBF) was measured at the start of surgery, during veno‐venous bypass and post reperfusion, using a method based on the Kety‐Schmidt method. Cerebral metabolism was assessed by measuring the cerebral metabolic rate for oxygen (CMRO 2 ) and the lactate oxygen index (LOI). The cerebral vascular reactivity to carbon dioxide (CO 2 ) was studied during the preanhepatic and post reperfusion phases. During the preanhepatic period, the median CBF was 44 mL/100 g/min at an arterial carbon dioxide tension (PaCO 2 ) of 3.8 kPa. After reperfusion the CBF increased ( P < .02) to 102 mL/100 g/min, the arterial hydrogen ion concentration increased from 39 nmol/L to 53 nmol/L ( P < .02) and the jugular venous oxygen saturation from 74% to 89% ( P < .02). CBF was similar in patients with and without encephalopathy. The cerebral vascular reactivity to CO 2 remained intact, although after reperfusion, the CBF for a given PaCO 2 was greater, and the slope of the CBF/CO 2 response curve diminished. The CMRO 2 was normal in patients without encephalopathy. In the encephalopathic patients, the CMRO 2 was low during all stages of transplantation (0.54, 0.86, 1.24 mL/100 g/min, respectively). Patients with encephalopathy may be at increased risk of hypoxemic brain injury during transplantation. To minimize this possibility, more detailed neurological monitoring may be useful.