LIVER MICROCIRCULATION AFTER PARTIAL HEPATECTOMY IN BILIARY CIRRHOSIS
E.A. ISKANDAROV, R.H. TOLBA
Scientific Surgery Center, Baku, AZERBAIJAN
HET, University Hospital, Bonn, GERMANY
Aim: To compare the hemodynamic features with different biliary cirrhosis (BC) duration after partial hepatectomy in rats.
Materials and methods: A total of 60 male Wistar rats weighing 250 to 280 g were used for experiment. Biliary cirrhosis was made by common bile duct ligation (CBDL) in 40 rats under isofluran anesthesia. The common bile duct was carefully exposed and double-ligated with silk threads, after which a 2 mm segment was resected between the ligatures to prevent recanalization. Rats were divided into two group 20 rats in either and were studied after 2 (A group), 4 weeks (B group) after CBDL. 20 rats in control group were undertaken to partial hepatectomy (70% of liver). The changes in hepatic homodynamic were studied after 1 and 3 hour after hepatectomy in control and CBDL groups. Liver microcirculation (LM) measured with Laser Doppler and Portal Flow (PF) with Transit time perivascular flowmeter (Transonic Systems Inc. TS 420). Standard liver function tests were performed with an autoanalyzer.
Results: In both CBDL groups, LM and PF were significantly lower than in control rats. Microcirculatory changes in liver vascular bed in control group 1 hour after hepatectomy easily normalized. In both CBDL rats 1 hour after liver resection significant changes in Laser Doppler parameters neither were nor detected. In A group rats, 3 hour after hepatectomy recovery of liver microcirculation was significantly better than in group B.
Conclusion: The disturbances in liver microcirculation after 2 weeks CBDL were deeper comparable to the rats with 4 week biliary cirrhosis duration, but survival was better than in another group. Our results show that the microcirculatory changes of the liver can be precisely investigated by Laser Doppler using the introduced standardization and transformations.
CLINICAL-HEMODYNAMIC FEATURES OF SOME MODERN METHODS OF GENERAL ANESTHESIA IN HEPOTOBILIARY SURGERY
Azerbaijan Medical University, Baku, AZERBAIJAN
The purpose of this work was to clinical-hemodynamically characterize some modern methods of general anesthesia during operations in liver and biliary tracts.
Studies involved 104 patients. Cholecystectomy was conducted on 101 of them and echinococcectomy of liver was conducted on 3 of them. Considering general anesthesia methods used, patients were divided into 3 groups: modified leptoanalgesia-NLA on 31 patients (I group), anesthesia balanced on ketamine and NLA preparations on 32 patients (II group), total intravenous anesthesia based on ketamine and ataralgesia preparations on 41 patients (III group) were conducted. Pre-operation preparations, induction of premedication, preanalgesia and anesthesia were the same in all groups. In the process of anesthesia and surgery operation, clinics of anesthesia were observed, electrocardiogram monitoring was conducted, arterial pressure (AP), the number of heart beats (NHB), the volume of heart beats (VHB), minute volume of heart (MVH), general peripheral vessel resistance (GPVR), the need of myocardium for oxygen and vegetative index of kerdon were studied.
It was revealed that multi-component premedecation created sufficient sedative effect and paid for stability of hemodynamic indicators. With application of transamin, preanalgesia and coinduction allowed mild access to anesthesia, prevented postincubatory hypertensia and tachycardia. More serious hemodynamic side effects were revealed in I group and this happens in most traumatic phase of the operation: statistic increase of GPVR and AP, the significant decrease of VHB and MVH, development of vegetative disbalance shows inadequacy of anesthesia on one hand and deepening of existing hypodynamia at the cost of negative impacts on cario-vascular system on the other hand. The development of various complications (in 4.5% of cases arrhythmia, 63.6% of cases myocardium ischemia, including micro miocardic insult in one patient) also proves the inefficiency of the method. Compared to comparison group, stability of hemodynamic homeostasis was observed in II and III groups. Electrocardiogram monitoring revealed 23.8% myocardium ischemia in II group and 8.3% in III group.
Summary: total intravenous anesthesia based on ketamine and ataralgesia preparations is distinguished with stability of hemodynamic homeostasis, however anesthesia balanced on NLA preparations also maintains relative stability of the indicators. But modified NLA is characterized with serious hemodynamic side effects.