Aspects of anaesthetic management of heterologous extracorporeal hepatic support in patients with acute liver failure.

Some anaesthetic aspects of heterologous extracorporeal hepatic support for patients with acute liver failure have been investigated in animals and men. Two types of anaesthesia during hepatectomy in pigs were performed in 20 experiments divided into two groups. A convenient anaesthetic technique was found to be the combined use of neuroleptanalgesics, gamma-OH, small doses of thiopental sodium and nitrous oxide--oxygen mixture. The necessity for care in the procedure of temporary liver support for 'poor-risk' patients is outlined. A minimal use of drugs which are metabolized by the liver, and avoidance of potent analgesics, narcotics, hypotension and hypoxia are the main principles for safe extracorporeal hepatic assistance to critically ill patients.

[Treatment of terminal forms of icterohemorrhagic leptospirosis]. / Lechenie terminal'nykh form ikterogemorragicheskogo leptospiroza.

Complex therapy, using hemosorption in combination with hemodialysis and hyperbaric oxygenation, was suggested for the treatment of patients with terminal stages of icterohemorrhagic leptospirosis. Such complex therapy decreased the mortality rate of patients with terminal stages of icterohemorrhagic leptospirosis from 76-96% to 18-22% and reduced the in-hospital stay from 60-80 to 35-40 days.

[Functional and biochemical parallels in two-stage devascularization of the liver]. / Funktsional'no-biokhimischeskie paralleli pri dvukhmomentnoi devaskuliarizatsii pecheni

Experiments were performed on mongrel dogs. Biochemical changes of the blood and functional disturbances in the organism were studied after a two-stage devascularization of the liver at different periods after the second stage, i.e. after the ligation of the hepatic artery. Early disturbances in the intermediary metabolism were the consequence of the two-stage devascularization, i.e. of the rise of the pyruvate and the lactate, an increase of ammonia in the blood and serum transaminases. Biochemical changes of the blood precede and accompany the encephalopathia and serious hemodynamic disturbances in the organism. The mentioned method was capable of causing hepatic coma.

[Absorptive-excretory function of isolated dog liver during its perfusion]. / Poglotitel'no-vydelitel'naia funktsiia izolirovannoi pecheni sobak v usloviiakh ee perfuzii

Twenty experiments were performed on mongrel dogs. The absorptive and excretory function of the liver in the intact organism and during its isolated perfusion through the portal vein with the use of extracorporeal circulation was studied by means of the bromsulfaline test. The absorptive function of the perfused liver proved to decrease by 50-60 per cent. The rate of bile elimination and plasma clearance was 5-6 times higher at the beginning of the experiment in the intact organism. Later on, the difference in the degree of retention of the hepatic excretory function was reduced. Hypoxia connected with denervation, hepatectomy and the isolated perfusion proper apparently served as the principal cause of reduction of the absorptive-excretory function of the isolated liver.

Intensive therapy for hepatic coma.

Of 45 patients observed in the ICU with severe acute hepatic insufficiency, 15 patients were in hepatic coma. All patients received combined treatment consisting of standard conservative methods (drug therapy) and surgical methods for temporary support of liver function (hemodialysis, exchange blood transfusion, pig liver perfusion). Intensive therapy which began during the early phase of hepatic coma enabled us to bring six patients out of the coma, four of whom completely recovered. These studies showed that of the diseases causing hepatic coma, the worst results were obtained with viral hepatitis. This may be explained both by the extensive liver damage and marked metabolic disturbances, which led to failure of other vital organs and systems. At present, the combined therapy contributes to a greater percentage of recovery of patients with hepatic failure and coma.