title: Increased carboxyhemoglobin level during liver resection with inflow occlusion.
abstract: Controlling stress responses associated with ischemic changes due to bleeding and ischemia/reperfusion injury is essential for anesthetic management. Endogenous carboxyhemoglobin (COHb) is produced in the oxidative degradation of heme proteins by the stress-response enzyme heme oxygenase. Although the COHb level is elevated in critically ill patients, changes in endogenous COHb during anesthesia have not been well investigated. Therefore, we evaluated changes in endogenous COHb levels in patients undergoing liver resections with inflow occlusion. Levels of COHb were significantly increased after the Pringle maneuver. The inflow occlusion time in patients with increased COHb after the Pringle maneuver (∆COHb > 0.3 %) was significantly longer than in patients without increased COHb (∆COHb < 0.3 %) (P = 0.01). In addition, COHb changes were correlated with inflow occlusion time (P = 0.005, R(2) = 0.21). Neither total blood loss, transfusion volume of packed red blood cells, operation time, nor anesthetic time differed between patients with and without increased COHb. The results indicated that endogenous COHb levels were increased by inflow occlusion in patients undergoing liver resections, which suggests that changes in COHb may correlate with hepatic ischemia/reperfusion injury induced by inflow occlusion.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Godai
authors.forename: Maiko
authors.initials: M
authors.lastname: Hasegawa-Moriyama
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuniyoshi
authors.forename: Akira
authors.initials: A
authors.lastname: Matsunaga
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kanmura
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000758:Anesthesia; D001219:Aspartate Aminotransferases / Q000097:blood; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002248:Carbon Monoxide / Q000097:blood; D002263:Carboxyhemoglobin / Q000378:metabolism*; D003250:Constriction; D006801:Humans; D008099:Liver / Q000601:surgery*; D008102:Liver Circulation / Q000502:physiology; D018384:Oxidative Stress / Q000187:drug effects; D015427:Reperfusion Injury / Q000378:metabolism; D060205:Therapeutic Occlusion
chemical_list: D002248:Carbon Monoxide; D002263:Carboxyhemoglobin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase