Liver ischemia, catecholamines and preoperative condition influencing postoperative tachycardia in liver surgery

The aim of our study was to assess the influence of intraoperative hypoxic stress -unavoidably brought about by so called Pringle maneuver - on free a nd conjugated catecholamines during major hepatic resection. Judging from e arlier results of fatigue-experiments in rats we also wanted to check the r elationship between of poor general preoperative condition and conspicuousl y low triglyceride serum concentrations. The study included 26 patients wit h primary and secondary liver tumors. The mean age was 54 years (range 27-7 9). Twenty-one patients had segmental liver resections, 3 had hemihepatecto mies and 2 hydatid cysts were treated by cystectomy. Blood samples were tak en 2 days before and throughout surgery. Catecholamine plasma values were d etermined by high performance liquid chromatography. Statistical comparison s were made by t-test, ANOVA and chi square test. Free plasma catecholamine s increased significantly during prolonged intraoperative ischemia (Pringle time 50-125 minutes). Patients with elevated intraoperative catecholamines had a significant correlation to postoperative episodes of tachycardia, an d prolonged hospital stay. On the other hand, we could also see postoperati ve tachycardias in patients with short Pringle times (18-49 minutes) but wi th decreased preoperative serum triglycerides as an indicator of chronic st ress and reduced general condition. Intraoperative hypoxic stress is associ ated with increased catecholamine values. Elevated catecholamines may well cause postoperative sinus-tachycardias (mean 20 hours) and are strongly rel ated to postoperative liver failure and prolonged hospital stay.