The monoethylglycinexylidide test is more useful for evaluating liver function than indocyanine green test: case of a patient with remarkably decreased indocyanine green half-life.
Lidocaine was used for evaluation of hepatic function in a patient undergoing hepatic resection. Preoperatively, half-life of indocyanine green (ICG) was 33 min after intravenous administration. Plasma concentration of the N-dealkylated metabolite of lidocaine, monoethylglycinexylidide (MEGX), was quantitatively determined to evaluate hepatic function. The patient's rate of formation of MEGX at 15 min after administration of lidocaine was within normal limits, at 56 micrograms/L. These findings suggest that in this patient, hepatic cytochrome P-450IIIA activity was not impaired, but selective impairment of uptake of ICG into hepatocytes or excretion into the bile ducts was present. The rate of formation of MEGX was decreased, and plasma concentration of bilirubin was elevated postsurgically; this could have been the result of decreased cytochrome P-450IIIA activity or decreased hepatic blood flow after hepatic resection. We conclude that the rate of formation of MEGX is a better index of hepatic function than is ICG half-life.
Oda
Y
Y
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Japan.
Kariya
N
N
Nakamoto
T
T
Nishi
S
S
Asada
A
A
Fujimori
M
M
D006801:Humans; D007208:Indocyanine Green / Q000032:analysis; D008012:Lidocaine / Q000031:analogs & derivatives* / Q000032:analysis / Q000378:metabolism; D008099:Liver / Q000601:surgery; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged
D008012:Lidocaine; C001173:monoethylglycinexylidide; D007208:Indocyanine Green