Review article: the role of the microcirculation in liver cirrhosis

Davies, Teifion; Wythe, Stephen; Martin, Daniel; Gilbert‐Kawai, Edward

doi:10.1111/apt.14279

Cited by 22 publications

(12 citation statements)

References 128 publications

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“…Patients who are infected with HBV may develop chronic liver disease. Patients with chronic liver disease usually have vascular dysfunction, especially angiogenesis, microvascular derangements and microcirculatory dysfunction [26, 27]. Cirrhosis causes numerous microscopic vessel aberrations, and these vessels may become entangled with each other, resulting in sharp bends, anomalous branching patterns, abnormal branching angles and tortuosity [28].…”

Section: Discussionmentioning

confidence: 99%

Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

Zhang

et al. 2019

BMC Anesthesiol

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Background Ultrasound guidance might decrease the incidence of local anesthetics systemic toxicity (LAST) for many peripheral nerve blocks compared with nerve stimulator guidance. However, it remains uncertain whether ultrasound guidance is superior to nerve stimulator guidance for deep nerve block of the lower extremity. This study was designed to investigate whether deep nerve block with ultrasound guidance would decrease the incidence of LAST compared with that with nerve stimulator guidance, and to identify associated risk factors of LAST. Methods Three hundred patients undergoing elective lower limb surgery and desiring lumbar plexus blocks (LPBs) and sciatic nerve blocks (SNBs) were enrolled in this study. The patients were randomly assigned to receive LPBs and SNBs with ultrasound guidance (group U), nerve stimulator guidance (group N) or dual guidance (group M). The primary outcome was the incidence of LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and nerve distribution restoration time, as well as associated risk factors. Results There were 18 patients with LAST, including 12 in group U, 4 in group N and 2 in group M. By multiple comparisons among the three groups, we found that the incidence of LAST in group U (12%) was significantly higher than that in group N (4%)( P = 0.037) and group M(2%)( P = 0.006). The OR of LAST with hepatitis B (HBV) infection and the female sex was 3.352 (95% CI,1.233–9.108, P = 0.013) and 9.488 (95% CI,2.142–42.093, P = 0.0004), respectively. Conclusions Ultrasound guidance, HBV infection and the female sex were risk factors of LAST with LPBs and SNBs. For patients infected with HBV or female patients receiving LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator guidance should be used to improve the safety. Trial registration This study was approved by the Ethical Committee of the First Affiliated Hospital of Army Medical University. The protocol was registered prospectively with the Chinese Clinical Trial Registry ( ChiCTR-IOR-16008099 ) on March 15, 2016.

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Section: Discussionmentioning

confidence: 99%

Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

Zhang

et al. 2019

BMC Anesthesiol

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“…Accordingly, haemodynamic changes have been demonstrated in a range of extrahepatic vascular beds using modern vascular imaging techniques [ 4 , 5 ]. However, although the macrocirculation has been extensively characterised in cirrhosis, the microcirculation has been relatively understudied [ 6 ]. Emerging data suggest that, as in patients with severe sepsis [ 7 ], dysregulated systemic inflammation and microcirculatory alterations in different cirrhosis phenotypes may correlate with poor clinical outcomes [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Eye as a Non-Invasive Window to the Microcirculation in Liver Cirrhosis: A Prospective Pilot Study

Gifford

Moroni

Farrah

et al. 2020

JCM

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Microcirculatory dysfunction is associated with organ failure, poor response to vasoactive drugs and increased mortality in cirrhosis, but monitoring techniques are not established. We hypothesized that the chorioretinal structures of the eye could be visualized as a non-invasive proxy of the systemic microvasculature in cirrhosis and would correlate with renal dysfunction. Optical Coherence Tomography (OCT) was performed to image the retina in n = 55 cirrhosis patients being assessed for liver transplantation. OCT parameters were compared with established cohorts of age- and sex-matched healthy volunteers (HV) and patients with chronic kidney disease (CKD). Retinal thickness, macular volume and choroidal thickness were significantly reduced relative to HV and comparable to CKD patients (macular volume: HV vs. cirrhosis mean difference 0.44 mm3 (95% CI 0.26–0.61), p ≤ 0.0001). Reduced retinal thickness and macular volume correlated with renal dysfunction in cirrhosis (macular volume vs. MDRD-6 eGFR r = 0.40, p = 0.006). Retinal changes had resolved substantially 6 weeks following transplantation. There was an inverse association between choroidal thickness and circulating markers of endothelial dysfunction (endothelin-1 r = −0.49, p ≤ 0.001; von Willebrand factor r = −0.32, p ≤ 0.05). Retinal OCT may represent a non-invasive window to the microcirculation in cirrhosis and a dynamic measure of renal and endothelial dysfunction. Validation in different cirrhosis populations is now required.

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“…Patients who had been infected with HBV may result in chronic liver disease. Patients with chronic liver disease usually had vascular dysfunction, especially angiogenesis, microvascular derangements and microcirculatory dysfunction [26,27] There are a number of limitations to this study. Firstly, it was not possible to blind the anesthesiologist performing the nerve block, we couldn't exclude the potential influence of a performance bias in this study.…”

Section: Discussionmentioning

confidence: 99%

Combined Ultrasound and Nerve Stimulator-Guided deep nerve block may decrease the rate of local anesthetics systemic toxicity especially in HBV carriers: A Randomized clinical trial

Zhang

et al. 2019

Preprint

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Background: Ultrasound-guidance might decrease the incidence of local anesthetics systemic toxicity(LAST) for many peripheral nerve blocks compared with nerve stimulator-guidance. However, it remained uncertain whether ultrasound-guidance would be superior to the nerve stimulator-guidance for deep nerve block in the lower extremity. This study was designed to investigate that whether ultrasound-guided deep nerve block would decrease the incidence of LAST comparing with those with nerve stimulator-guidance, and to find out associated risk factors for LAST. Methods: Three hundred patients for elective lower limb surgery and desiring lumbar plexus blocks(LPBs) and sciatic nerve blocks(SNBs) were enrolled in this study. Patients were randomly assigned to receive LPBs and SNBs with ultrasound-guidance (Group U), nerve stimulator-guidance (Group N) or dual-guidance (Group M). The primary outcome was the incidence of the LAST. The secondary outcomes were the number of needle redirection, motor and sensory block onset and restoration time in the nerve distributions, and associated risk factors. Results: There were 18 patients occurring with LAST, including 12 in group U, 4 in group N and 2 in group M. For multiple comparisons among the three groups, we found that the incidence of LAST in group U(12%) was significantly higher than that in group N(4%)(P=0.037) and group M(2%)(P=0.006). The OR of LAST with hepatitis B （HBV） infection and female gender were 3.352(95% CI,1.233-9.108, P=0.013 ) and 9.488(95% CI,2.142-42.093, P=0.0004), respectively. Conclusions: Ultrasound-guidance, HBV infection and female gender were risk factors for LAST in LPBs and SNBs. For patients with HBV infection or female gender undergoing LPBs and SNBs, we recommended that combined ultrasound and nerve stimulator-guidance should be used to improve the safety. Trial registration: This study was approved by the Ethical Committee from the first affiliated hospital of Army Medical University. The protocol was registered prospectively with Chinese Clinical Trial Registry (ChiCTR-IOR-16008099) on March 15th，2016. Key words: ultrasound; nerve stimulation; nerve block; female; HBV; LAST

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Review article: the role of the microcirculation in liver cirrhosis

Cited by 22 publications

References 128 publications

Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

Combined ultrasound and nerve stimulator-guided deep nerve block may decrease the rate of local anesthetics systemic toxicity: a randomized clinical trial

The Eye as a Non-Invasive Window to the Microcirculation in Liver Cirrhosis: A Prospective Pilot Study

Combined Ultrasound and Nerve Stimulator-Guided deep nerve block may decrease the rate of local anesthetics systemic toxicity especially in HBV carriers: A Randomized clinical trial

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