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Behaviour of Mg in Patients During Recreation from Extensive Liver Surgery

H. Bacher, M.D., Professor of Surgery, 1st Surgical Department, University of Graz, Medical School.

The aim of our study was to assess the influence of intraoperative hypoxic stress –unavoidably brought about by so called Pringle maneuver - on free and conjugated catecholamines during major hepatic resection. Judging from earlier results of fatigue-experiments in rats we also wanted to check the relationship between poor general preoperative condition and conspicuously low triglyceride serum concentrations as well as the behaviour of serum magnesium. The study included 26 patients with primary and secondary liver tumors. The mean age was 54 years (range 27-79). Twenty-one patients had segmental liver resections, 3 had hemihepatectomies and 2 hydatid cysts were treated by cystectomy. Blood samples were taken 2 days before and throughout surgery. Catecholamine plasma values were determined by high performance liquid chromatography. Statistical comparisons were made by t-test, ANOVA and chi square test. Free plasma catecholamines increased significantly during prolonged intraoperative ischemia (Pringle time 50-125 minutes). Patients with elevated intraoperative catecholamines had a significant correlation to postoperative episodes of tachycardia, and prolonged hospital stay. On the other hand, we could also see postoperative tachycardias in patients with short Pringle times (18-49 minutes) but with decreased preoperative serum triglycerides as an indicator of chronic stress and reduced general condition. Intraoperative hypoxic stress is associated with increased catecholamine values. Elevated catecholamines may well cause postoperative sinus-tachycardias (mean 20 hours) and are strongly related to postoperative liver failure and prolonged hospital stay. Additionally, peculiar behaviour of Mg during recreation, dependent upon the different status of the patients was. seen, whereby drastic falls in Mg could be prevented by dopamine infusions. Since low Mg exerts well known reactions upon the heart, an additional possibility for the tachycardia is discussed.


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