Monoethylglycinexylidide extraction level as a measure of hepatic detoxification and excretion functions in cirrhotics undergoing laparoscopic cholecystectomy under general anesthesia

Objectives: To estimate plasma monoethylglycinexylidide (MEGX) level at 15 and 30 min after intravenous injection of lidocaine as a measure for detoxification and excretory function of the liver in cirrhotic patients in comparison with non-cirrhotic patients assigned for laparoscopic cholecystectomy (LC). Patients and methods: The study included 50 cirrhotic and 10 non-cirrhotic patients assigned for LC. Only Child-Pugh (CP) class A or B patients with adjusted liver functions were included in the study. Both patients and controls received anesthesia using a similar protocol. Intravenous lidocaine (1 mg/kg) was injected over 1 min, and blood samples were obtained immediately before lidocaine injection (S0) to assure absence of MEGX in plasma and 15 min (S-15) and 30 min (S-30) after lidocaine administration. MEGX values > 90 ng/ml are considered normal. The extent of MEGX extraction was calculated as plasma MEGX level at S-30 minus S-15. Results: Mean operative and anesthesia times were 59.3 +/- 10.4 and 73.9 +/- 12.2 min, respectively. Mean sevoflurane 18.1 +/- 2.4 ml/h. Operative and anesthetic data showed non-significant difference between patients categorized according to CP class and in comparison with controls. Estimated plasma MEGX levels at 15-min and 30-min after lidocaine injection were significantly higher in controls compared to patients and in patients of CP class A compared to those of class B. The extent of extraction was significantly lower in patients of CP class B compared both to controls and patients of class A with non-significantly lower extraction level in patients of class A compared to controls. Conclusion: Laparoscopic cholecystectomy is safe and feasible in cirrhotic patients and MEGX test as a measure of detoxification and excretory function of the liver is a reliable test that showed a relationship to the extent of hepatic derangement. (C) 2013 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Anesthesiologists.