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.
Abbreviations
- AST:
-
Aspartate transaminase
- ALT:
-
Alanine transaminase
- CO:
-
Carbon monoxide
- COHb:
-
Carboxyhemoglobin
- FiO2 :
-
Fraction of inspired oxygen
- Hb:
-
Hemoglobin
- PRBC:
-
Packed red blood cells
References
Otterbein LE, Choi AM. Heme oxygenase: colors of defense against cellular stress. Am J Physiol Lung Cell Mol Physiol. 2000;279:L1029–37.
De las Heras D, Fernandez J, Gines P, Cardenas A, Ortega R, Navasa M, Barberá JA, Calahorra B, Guevara M, Bataller R, Jiménez W, Arroyo V, Rodés J. Increased carbon monoxide production in patients with cirrhosis with and without spontaneous bacterial peritonitis. Hepatology. 2003;38:452–9.
Owens EO. Endogenous carbon monoxide production in disease. Clin Biochem. 2010;43:1183–8.
Schober P, Kalmanowicz M, Schwarte LA, Loer SA. Cardiopulmonary bypass increases endogenous carbon monoxide production. J Cardiothorac Vasc Anesth. 2009;23:802–6.
Ryter SW, Choi AM. Heme oxygenase-1/carbon monoxide: from metabolism to molecular therapy. Am J Respir Cell Mol Biol. 2009;41:251–60.
van der Bilt JD, Livestro DP, Borren A, van Hillegersberg R, Borel Rinkes IH. European survey on the application of vascular clamping in liver surgery. Dig Surg. 2007;24:423–35.
Clavien PA, Petrowsky H, DeOliveira ML, Graf R. Strategies for safer liver surgery and partial liver transplantation. N Engl J Med. 2007;356:1545–59.
Hayashi M, Takahashi T, Morimatsu H, Fujii H, Taga N, Mizobuchi S, Matsumi M, Katayama H, Yokoyama M, Taniguchi M, Morita K. Increased carbon monoxide concentration in exhaled air after surgery and anesthesia. Anesth Analg. 2004;99:444–8.
McGrath JJ. Effects of altitude on endogenous carboxyhemoglobin levels. J Toxicol Environ Health. 1992;35:127–33.
Ziemann-Gimmel P, Schwartz DE. Increased carboxyhemoglobin in a patient with a large retroperitoneal hematoma. Anesth Analg. 2004;99:1800–2.
Ehlers M, McCloskey D, Devejian NS. Alarming levels of carboxyhemoglobin in a unit of banked blood. Anesth Analg. 2003;97:289–90.
Adachi T, Hirota K, Hara T, Sasaki Y, Hara Y. Exhaled carbon monoxide levels change in relation to inspired oxygen fraction during general anesthesia. Anesth Analg. 2007;105:696–9.
Ernst A, Zibrak JD. Carbon monoxide poisoning. N Engl J Med. 1998;339:1603–8.
Holak EJ, Mei DA, Dunning MB 3rd, Gundamraj R, Noseir R, Zhang L, Woehlck HJ. Carbon monoxide production from sevoflurane breakdown: modeling of exposures under clinical conditions. Anesth Analg. 2003;96:757–64.
Wissing H, Kuhn I, Warnken U, Dudziak R. Carbon monoxide production from desflurane, enflurane, halothane, isoflurane, and sevoflurane with dry soda lime. Anesthesiology. 2001;95:1205–12.
Touger M, Gallagher EJ, Tyrell J. Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning. Ann Emerg Med. 1995;25:481–3.
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Godai, K., Hasegawa-Moriyama, M., Kuniyoshi, T. et al. Increased carboxyhemoglobin level during liver resection with inflow occlusion. J Anesth 27, 306–308 (2013). https://doi.org/10.1007/s00540-012-1513-4
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DOI: https://doi.org/10.1007/s00540-012-1513-4