Monoethylglycinexylidide extraction level as a measure of hepatic detoxification and excretion functions in cirrhotics undergoing laparoscopic cholecystectomy under general anesthesia

Abstract

ObjectivesTo estimate plasma monoethylglycinexylidide (MEGX) level at 15 and 30 min after intravenous injection of lidocaine as a measure for detoxification and excretory function of the liver in cirrhotic patients in comparison with non-cirrhotic patients assigned for laparoscopic cholecystectomy (LC).Patients and methodsThe study included 50 cirrhotic and 10 non-cirrhotic patients assigned for LC. Only Child-Pugh (CP) class A or B patients with adjusted liver functions were included in the study. Both patients and controls received anesthesia using a similar protocol. Intravenous lidocaine (1 mg/kg) was injected over 1 min, and blood samples were obtained immediately before lidocaine injection (S0) to assure absence of MEGX in plasma and 15 min (S15) and 30 min (S30) after lidocaine administration. MEGX values > 90 ng/ml are considered normal. The extent of MEGX extraction was calculated as plasma MEGX level at S30 minus S15.ResultsMean operative and anesthesia times were 59.3 ± 10.4 and 73.9 ± 12.2 min, respectively. Mean sevoflurane 18.1 ± 2.4 ml/h. Operative and anesthetic data showed non-significant difference between patients categorized according to CP class and in comparison with controls. Estimated plasma MEGX levels at 15-min and 30-min after lidocaine injection were significantly higher in controls compared to patients and in patients of CP class A compared to those of class B. The extent of extraction was significantly lower in patients of CP class B compared both to controls and patients of class A with non-significantly lower extraction level in patients of class A compared to controls.ConclusionLaparoscopic cholecystectomy is safe and feasible in cirrhotic patients and MEGX test as a measure of detoxification and excretory function of the liver is a reliable test that showed a relationship to the extent of hepatic derangement.