Präoperative Katecholamin-Effekte auf Blutfette und Magnesiumwerte können ein Leberversagen nach Leberresektionen vorhersagen

Abstract

BACKGROUND: Our previous investigations demonstrated that there is an enormous increase in free catecholamines during prolonged intraoperative occlusion of blood flow to the liver (Pringle maneuver), with tachycardias indicating impending postoperative liver failure. As stress-induced changes in catecholamine levels also have clear metabolic consequences, we investigated changes in catecholamines and their metabolites before, during, and after surgery, looking for simple risk parameters that could serve as early onset predictors of postoperative liver failure. METHODS: We examined 26 patients with primary and secondary liver tumors. Their average age was 54 years (range, 27–79). Twenty-one patients had segmental liver resections, 3 had hemihepatectomies, and 2 hydatid cysts were treated by pericystectomy. Blood samples were taken 2 days before and during all phases of surgery and the following parameters were determined: free plasma epinephrine, total serum calcium and magnesium, serum triglycerides, and serum cholesterol. Catecholamine plasma values were determined by high-performance liquid chromatography. The patients were subdivided into 2 groups: one including those with postoperative liver failure; and the other, those without liver failure. Statistical analysis was performed with Clinical Stress Assessment Software. RESULTS: In patients with liver failure (LF), perioperative catecholamine increase was about threefold higher when compared to the increase observed in non-liver failure patients (nLF). However, there were no preoperative differences in catecholamine levels among the groups. Unlike the results for the catecholamines, there were significant preoperative differences in cholesterol, triglycerides, and total magnesium values, which were all lower in the LF group. Perioperative fall in cholesterol correlated significantly with decreased calcium levels, an electrolyte well known to be discharged from the blood stream into tissues with increasing catecholamine effect. Such an increase could also be shown by perioperative positive correlations between glutamic oxalacetic transaminase and epinephrine. CONCLUSIONS: Estimation of the risk of postoperative liver failure is of great importance for the surgeon and the patient. Disproportionately large increases in catecholamines in the LF group point towards a relative increase in surgical stress in persons who already are metabolically maladapted. Such metabolic exhaustion is well documented by preoperative "pseudonormal", i.e., relatively low cholesterol and triglyceride levels, that are usually not to be expected in middle-aged patients. Along with low magnesium concentrations, such parameters can be used as preoperative predictors for postoperative liver failure.