Endocrine and hemodynamic changes during liver surgery in patients with compensated liver cirrhosis

The purpose of this study was to determine hormonal levels in compensated liver cirrhotic patients under general anesthesia before and after liver surgery. We measured plasma norepinephrine, epinephrine, arginine vasopressin, and aldosterone levels and renin activity in non-cirrhotic and compensated cirrhotic patients undergoing liver resection after induction of anesthesia but before skin incision and after the end of operation but before discontinuation of nitrous oxide. We simultaneously measured hemodynamic variables. Plasma levels of norepinephrine (P 0.001), epinephrine (P 0.001), arginine vasopressin (P 0.05), renin (P 0.05) and aldosterone (P 0.001) significantly increased after completion of surgery compared with those before incision in both groups. There was a significant positive correlation between plasma renin and aldosterone (r = 0.56, P 0.01) levels in non-cirrhotics, but no correlation was observed in cirrhotics; and there was a significant positive correlation between plasma norepinephrine and arginine vasopressin (r = 0.45, P 0.05) levels in non-cirrhotics, but no correlation in cirrhotics. Cardiac index and arterial pressure increased after the end of operation (P 0.05). This increase after the operation was the same between cirrhotic and non-cirrhotic groups. There were no changes in heart rate, mean pulmonary arterial pressure, and pulmonary capillary wedge pressure after the end of operation. We conclude that hemodynamic and endocrinological changes were similar between compensated cirrhotic patients and non-cirrhotic patients during liver surgery. Endocrine changes might partly explain the hemodynamic changes during surgery.(Maruyama K, Sakakura S, Nishimura K, et al.: Endocrine and hemodynamic changes during liver surgery in patients with compensated liver cirrhosis. J Anesth 7: 157–166, 1993)