[Anesthetic experience of a patient for splenectomy with severe liver dysfunction and hyperammonemia].
A case of a patient with severe liver dysfunction and hyperammonemia undergoing splenectomy and liver biopsy was reported. Preoperative examination revealed that this patient's liver function was severely impaired due to liver cirrhosis (ICG15 = 60%, HPT = 29%, serum NH3 = 110 micrograms.dl-1). Preoperatively, kanamycin 2 g.day-1 and lacturose 60 ml.day-1 were given and FFP 3-5 units.day-1 were infused. With no premedication, general anesthesia was induced with dTc 3 mg, thiopental 200 mg and SCC 80 mg. Anesthesia was maintained with N2O-O2-enflurane and pancuronium. Though N2O concentration was kept at 50% to prevent intraoperative hypoxemia, the necessary enflurane concentration was low (almost 1% or lower). Serum NH3 level during operation was stable (100-110 micrograms.dl-1), and the level decreased (66-90 micrograms.dl-1) postoperatively. Postoperatively, this patient's consciousness level fluctuated with or without flapping tremor. The treatment of hepatic encephalopathy with lactulose, aminoleban EN and maalox were effective. Problems of perioperative and anesthetic management of a patient for upper abdominal surgery with severe liver dysfunction associated with hyperammonemia were discussed.
Kobayashi
S
S
Department of Anesthesiology, Toranomon Hospital, Tokyo.
Sato
Y
Y
Kawate
M
M
Yoshikawa
H
H
D000641:Ammonia / Q000097:blood*; D000769:Anesthesia, Inhalation; D004737:Enflurane; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009609:Nitrous Oxide; D010100:Oxygen; D013156:Splenectomy
D000641:Ammonia; D004737:Enflurane; D009609:Nitrous Oxide; D010100:Oxygen