Departments of 1Anaesthesia, Critical Care and Pain Medicine and 2Clinical Biochemistry, Royal Infirmary, Lauriston Place, Edinburgh EH3 9YW, UK*Corresponding author
Accepted for publication: September 29, 2001
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Abstract |
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Methods. We studied the effects of spinal anaesthesia on GST concentrations measured by specific radioimmunoassay in 33 patients undergoing intermediate orthopaedic, general or gynaecological surgery. GST concentrations were measured before anaesthesia and 3, 6 and 24 h after induction of anaesthesia. Hypotension (systolic blood pressure <70% of pre-induction value) was rapidly corrected with i.v. ephedrine.
Results. Mean duration of surgery was 41 min (range 1180). No increase in GST concentration was observed at any time, but at 24 h GST concentration was significantly reduced (P<0.05). One patient in whom hypotension was not treated developed a greatly increased GST concentration at 3 h.
Conclusion. We found no association between spinal anaesthesia and disturbance of hepatocellular integrity when hypotension does not occur or is rapidly corrected.
Br J Anaesth 2002; 88: 2857
Keywords: anaesthetic techniques, subarachnoid; liver, hepatotoxicity; enzymes, glutathione S-transferase
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Introduction |
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Methods and results |
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Premedication was with an oral benzodiazepine 1 h before surgery. Spinal anaesthesia was induced in the lateral position at the L3/4 interspace, using either 2% lidocaine, 0.5% bupivacaine or 0.5% bupivacaine in 8% dextrose (heavy bupivacaine) as indicated clinically. Midazolam was given intravenously for sedation if required. Patients received i.v. Ringer lactate solution 5001000 ml during surgery. Arterial pressure was measured every 5 min throughout anaesthesia; heart rate and oxygen saturation were monitored continuously. Hypotension, defined as systolic blood pressure <70% of pre-induction value for >5 min, was corrected with i.v. ephedrine.
Blood was sampled into heparin tubes immediately before induction of anaesthesia and 3, 6 and 24 h later for measurement of plasma GST B1 concentration (or class GST) by specific radioimmunoassay.5 The reference range for GST B1 concentration is 0.54.8 µg litre1.
Data were analysed by Friedmans test for repeated measurements. The Wilcoxon signed rank test was used to examine changes in GST concentration from before anaesthesia to 3, 6 and 24 h after induction of anaesthesia. Analysis was performed with Minitab for Windows (version 12).
Of the 34 patients studied, one was excluded from analysis because of lost samples. Data from the remaining 33 (18 male; mean age 57 (range 2281) yr) were analysed. This sample size gave the study a power of 78% for a change in GST concentration >0.7 µg litre1. Sixteen patients had orthopaedic surgery such as knee arthroscopy, tendon repair or fixation of lower limb fractures; 12 patients had general surgical procedures such as inguinal hernia repair or haemorrhoidectomy, and the remaining five patients had pelvic floor repair. Mean duration of surgery was 41 (range 1180) min. Five patients received 2% lidocaine (mean 3.75 ml), 10 received 0.5% plain bupivacaine (mean 3.25 ml) and 18 received 0.5% heavy bupivacaine (mean 3.04 ml). Twenty-one patients received midazolam (mean dose 4.4 (range 210) mg).
Median (interquartile range) GST concentrations (µg litre1) were: before anaesthesia, 2.25 (1.7, 2.9); 3 h, 2.1 (1.8, 3.4); 6 h, 2.0 (1.5, 3.85); 24 h, 1.8 (1.4, 2.95). Significant temporal changes in GST concentration occurred after anaesthesia (P<0.05). No increase in GST concentration was observed, but at 24 h GST concentration was significantly less than that found before anaesthesia (Fig. 1). Three patients (9%) developed GST concentrations >4.8 µg litre1 during the study period; one patient had a greatly increased (more than twice the upper limit of the reference range) GST concentration at 24 h. Three patients had GST concentration >4.8 µg litre1 in blood samples obtained before anaesthesia. The mean maximum (range) reduction in systolic blood pressure during spinal anaesthesia was 27 (057)%. Seven patients required correction of hypotension with i.v. ephedrine (total dose 612 mg). Two of these patients had received 2% lidocaine, one had received 0.5% plain bupivacaine and four had received 0.5% heavy bupivacaine. One further patient developed hypotension (52% reduction in systolic blood pressure) which inadvertently was not corrected with ephedrine; GST concentration increased greatly at 3 h in this patient (7.2 µg litre1 compared with 1.8 µg litre1 before anaesthesia). Overall changes in GST concentration were not related to hypotension, type of local analgesia used for spinal anaesthesia or administration of midazolam.
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Comment |
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Acknowledgement |
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References |
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2 Tiainen P, Lindgren L, Rosenberg PH. Changes in hepatocellular integrity during and after desflurane or isoflurane anaesthesia in patients undergoing breast surgery. Br J Anaesth 1998; 80: 879[ISI][Medline]
3 Hussey AJ, Aldridge LM, Paul D, Ray DC, Beckett GJ, Allan LG. Plasma glutathione S-transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane. Br J Anaesth 1988; 60: 1305[Abstract]
4 Kennedy WF, Everett GB, Cobb LA, Allen GD. Simultaneous systemic and hepatic hemodynamic measurements during high spinal anesthesia in normal man. Anesth Analg 1970; 49: 101623[Medline]
5 Beckett GJ, Hayes JD. Development of specific radioimmunoassays for the measurement of human hepatic basic and N/A2b glutathione S-transferase. Clin Chim Acta 1984; 141: 26773
6 Darling JR, Murray JM, Hainsworth AM, Trinick TR. The effect of isoflurane or spinal anesthesia on indocyanine green disappearance rate in the elderly. Anesth Analg 1994; 78: 7069[Abstract]
7 Nakayama M, Kanaya N, Fujita S, Namiki A. Effects of ephedrine on indocyanine green clearance during spinal anesthesia: evaluation by the finger piece method. Anesth Analg 1993; 77: 9479[Abstract]
8 Aldridge LM, Ray DC, Noble DW, Howie AF, Beckett GJ, Drummond GB. Glutathione S-transferase measurement can detect impaired hepatocellular integrity in anaesthetised, ventilated subjects. Clin Chem Enzym Commun 1993; 5: 195203
9 Ray DC, Aldridge LM, Spens HJ, Drummond GB, Howie AF, Beckett GJ. Biological variation and the effect of fasting and halothane anesthesia on plasma glutathione S-transferase concentrations. Clin Chem 1995; 41: 66871