Anhepatic phase

Veroli P, O Kelly B, Bertrand F, et al. Extrahepatic metabolism of propofol in man during the anhepatic phase of orthotopic liver transplantation. Br J Anaesth 1992 68(2) 183-186. 

In humans, midazolam is rapidly and almost completely metabolized to its primary f-hydroxy metabolite and, to a much lesser extent, to 4-hydroxymidazolam. Both of these pathways are selectively mediated by CYP3A (311,312). In addition, both intestinal and hepatic microsomes exhibit high midazolam hydrox-ylation activity, which in the case of the liver is significantly correlated with the drug s systemic clearance (313). Moreover, scale-up of such in vitro measures (282) was found to provide an excellent prediction of the in vivo extraction ratios of the two organs (313,314). Liver dysfunction markedly impairs midazolam s elimination (315,316), and plasma levels during the anhepatic phase of liver... 

Venous bypass Insertion of a combined venovenous and portoven-ous bypass reduces the negative effects of the anhepatic operative phase (lasting 30-120 minutes) by interrupting the blood flow in the portal vein and inferior vena cava. This measure allows greater haemodynamic stability during the anhepatic phase. 

In patients undergoing liver transplantation, the dosage requirements for pancuronium and vecuronium by intravenous infusion were reduced by 57 and 50% respectively during the anhepatic phase (SEDA-17, 153), whereas atracurium requirements were not altered by exclusion of the liver from the circulation. 

The transplanted liver, in contrast to kidney, is placed ortho-topicaUy the recipient s own liver must be removed. Liver transplant occurs in several phases removal of recipient hver, donor graft revascularization, and bihary reconstruction. During the anhepatic phase, the patient is placed on venovenous bypass to preserve venous return from the kidney and lower extremities. Size may be a limiting factor in liver transplantation. Donor and recipient are usually matched for size ( 20%) to prevent splinting of the diaphragm and pulmonary complications that would result from transplantation of an excessively large hver. ... 

Battezzati, A., A. Caumo, A. Fattorini, L.P. Sereni, J. Coppa, R. Romito, M. Ajnmatuna, E. Regalia, V. Mazzaferro and L. Luzi, 2002 Amino acid kinetics during the anhepatic phase of liver transplantation. Diabetes 51, 1690-1698. 

Joseph, S.E., N. Heaton, D. Potter, A. Pemet, M.A. Umpleby and S.A. Amiel, 2000 Renal glucose production compensates for the liver during the anhepatic phase of liver transplantation. Diabetes 49, 450-456. 

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