[Intraoperative changes in aerobic and anaerobic metabolism as prognostic index in interventions of massive hepatic...

This study was conducted on 10 patients with primitive or metastatic liver tumors, scheduled for massive liver resections, in order to search for evidence of the existence of intraoperative prognostic indexes having a bearing upon postoperative survival. The following parameters were measured in every patient: HR, MAP, CVP, MPAP, WP, SVR, PVR, CI, DO2, VO2, BE, before the anhepatic period (A), during anhepatic period (B), 30' (C), and 60' (D) after liver reperfusion, holding constant Hct, body temperature, ETCO2, FiO2, anesthetic depth, and the degree of muscular relaxation. The patients were later divided into two groups: 1, nonsurvivors in the postoperative period (4 patients) due to MOF; 2, survivors (6 patients). The values of the measured parameters of the two groups were statistically evaluated at each of the above intervals, and within each group with respect to time A, taken as a control. No significant variations were found in HR, MAP, CVP, MPAP, WP, SVR, PVR, CI, and DO2. The VO2 diminished in both groups during the anhepatic period (B) (p less than 0.0025). In group 1 (nonsurvivors) the VO2 diminished after the reperfusion (p less than 0.0025), while in group 2 (survivors) VO2 rapidly resumed its initial values (n.s. 30' and 60' after the reperfusion). In the nonsurviving patients metabolic acidosis developed, with significant reductions of BE (p less than 0.0025) during times C and D, occurring simultaneously with the reduction of VO2.(ABSTRACT TRUNCATED AT 250 WORDS)