Effect of penehyclidine hydrochloride on gastric mucous membrane impairment during orthotopic liver transplantation

Abstract

Objective To evaluate the effect of penehyclidine hydrochloride on gastric mucous membrane impairment during orthotopic liver transplantation (OLT) .Methods Thirty-eight ASA Ⅲ or Ⅳ patients aged 38-59 yr weighing 50-75 kg were randomly divided into 2 groups ( n = 19 each) : control group (C) and penehyclidine hydrochloride group (PH) . Penehyclidine hydrochloride 0.04 mg/kg in 50 ml of nomal saline (NS) was infused iv over 1 h after skin incision in group PH. Anesthesia was induced with midazolam, fentanyl, propofol and atracurium and maintained with isoflurane inhalation and infusion of propofol and atracurium. Radial artery was cannulated for blood sampling and BP monitoring. Swan-Ganz catheter was placed via right internal jugular vein. Gastric intramucosal tonometry catheter was inserted into the stomach. Gastric intramural pH and PCO_2 (pHi, PgCO_2) and arterial pH and PCO_2 ( pHa, PaCO_2 ) were measured immediately before operation (T_0, baseline) , 30 min before anhepatic phase (T_1 ) , 5, and 30 min of anhepatic phase (T_2 , T_3 ), 5, 30 and 60 min of neohepatic phase (T_4 , T_5 , T_6 ) and at the end of the operation (T_7 ) . Pg-aCO_2 was calculated. Results pHi and pHa significantly decreased while Pg-aCO_2 significantly increased at T_(2～5) as compared with the baseline values at T_0 in both groups. pHi and pHa values were significantly larger while Pg-aCO_2 was significantly smaller at T_(2～5) in group PH than in group C. Conclusion Intravenous penehyclidine hydrochloride 0.04 mg/kg can raise gastric intramural pH and protect gastric mucous membrane against injury. Key words: Cholinergic antagonists; liver transplantation; Gastric mucosa