British Journal of Anaesthesia, Vol 82, Issue 5 691-697, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
C. Lentschener, D. Franco, H. Bouaziz, F. J. Mercier, B. Fouqueray, C. Landault, J. X. Mazoit and D. Benhamou
Portal triad clamping (PTC) reduces venous return of blood to the heart.
However, the decrease in cardiac index (CI) is associated with an
unexpected increase in mean arterial pressure (MAP) and the 40% increase in
systemic vascular resistance is greater than anticipated in compensation
for the 10% decrease in CI. We hypothesized that a reflex elicited in the
peritoneum accounted for this unanticipated haemodynamic response. Twenty
patients undergoing liver resection were allocated randomly to have hepatic
pedicle infiltration before PTC with either lidocaine 200 mg or placebo.
MAP was recorded, and plasma osmolality and plasma concentrations of
vasopressin, epinephrine, norepinephrine, dopamine, renin and endothelin
were measured. After PTC, MAP increased significantly in the placebo group
but decreased significantly in the lidocaine group. Plasma concentrations
of vasopressin, epinephrine and norepinephrine increased significantly in
the placebo group. Plasma concentrations of vasopressin decreased
significantly in the lidocaine group, while plasma concentrations of
epinephrine and norepinephrine were unchanged. A subsequent study in eight
patients found that neither haemodynamic nor hormonal changes associated
with PTC in the placebo group were altered by administration of lidocaine
200 mg i.m. before PTC.
CLINICAL INVESTIGATIONS
Haemodynamic changes associated with portal triad clamping are suppressed by prior hepatic pedicle infiltration with lidocaine in humans
Department of Anaesthesiology and Department of Surgery, Universite Paris-Sud, Hopital Antoine-Beclere, 157, rue de la Porte de Trivaux, F-92141 Clamart Cedex, France; Clinical Investigation Laboratory, Universite Paris VI, Hopital Tenon, 4 Rue de la Chine, F-75020 Paris, France; Department of Biochemistry, Universite Paris VI, Hopital La Pitie, 47 Boulevard de l'Hopital, F-75651 Paris Cedex 13, France; Department of Anaesthesiology and Anaesthesiology Laboratory, Universite Paris-Sud, Hopital de Bicetre, 78 Avenue du General Leclerc, F-94275 Le Kremlin Bicetre Cedex, France
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