Continuous Venous Infusion of Adenosine in Patients Undergoing Partial Liver-Resection - a Potential Method to Reduce Ischemia-Reperfusion Damage?

Matthias Feuerecker1 , Quirin Zangl2 , Andre Martignoni3 , Ines Kaufmann4 , Manfred Thiel5# and Alexander Chouker1*

1 Department of Anesthesiology, Laboratory of Translational Research "Stress and Immunity", University Hospital, LMU Munich, Munich, Germany 2 Department of Anesthesiology, Perioperative and General Critical Care Medicine, Salzburg General Hospital, Paracelsus Medical University, Salzburg, Austria 3 Department of Anesthesiology, University Hospital Augsburg, Augsburg, Germany 4 Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, Municipal Hospitals of Munich, Muenchen Klinik, Krankenhaus Neuperlach, Munich, Germany 5 Department of Anesthesiology and Intensive Care, University of Heidelberg, Medical Faculty at Mannheim, Mannheim, Germany # Both authors contributed equally to this work

^*Correspondance to: Alexander Chouker 

 PDF  Full Text DOI: 10.25107/2474-1647.2963

Abstract

Purpose: Hepatic ischemia-reperfusion injury following Pringle maneuver during liver surgery has significant impact on postoperative hepatic function. The purpose of this study was to determine if continuously infused adenosine can prevent/reduce the hepatic ischemia-reperfusion injury. Method: This study focused on the pharmacological pre- and/or post-conditioning by intra venous adenosine infusion in 23 humans scheduled for liver surgery including Pringle's maneuver. Result: Plasma adenosine concentrations measured in central venous and arterial samples revealed a clearance of adenosine of almost 94% after lung passage in the arterial samples. Adenosine plasma concentrations in portal venous samples were not affected by adenosine infusion. Inflammatory, hepatocellular and ischemic markers were not different between the control group, the preconditioning group or the pre- and post-conditioning group. Conclusion: This preliminary study shows that high doses of central-venous infused adenosine could neither affect systemic inflammation nor the degree of effector organ (liver) damage as a result of surgical trauma and ischemia and reperfusion. Because of the impossibility of sufficient systematic metabolic tissue monitoring, the absence of hepatic effects might be best attributed to non-sufficiently high concentrations of adenosine at the target organ.

Keywords

Pre-conditioning; Post-conditioning; Adenosine infusion; Partial liver resection; Pringle maneuver; Humans

Cite the article

Feuerecker M, Zangl Q, Martignoni A, Kaufmann I, Thiel M, Chouker, A. Continuous Venous Infusion of Adenosine in Patients Undergoing Partial Liver-Resection - a Potential Method to Reduce IschemiaReperfusion Damage?. Clin Surg. 2020; 5: 2963.