sodium-oxybate and Cholestasis

The causes of the development of hepatic insufficiency in patients with obstructive jaundice after nondosed surgical decompression of the biliary tract are analysed. The high efficacy of preoperative hemosorption in prevention of this complication was demonstrated in experiments on 120 animals. Similar results were obtained in the clinic in 60 patients. Five-day treatment with solutions of glucose, contrycal (gordox), and sodium thiosulfate improved the results of treatment of obstructive jaundice in 600 experimental jaundice, whereas aldactone, prednisolone, sodium oxybutyrate and methacine were poorly effective. In experiments with prolongation of the preoperative therapy to 8 days the mortality increased. Glucose, contrycal (gordox), sodium thiosulfate, sodium oxybutyrate, and aldactone given in the postoperative period increased the survival of the animals. It is suggested that the 4-5-day preoperative management of patients with obstructive jaundice should include contrycal (gordox), sodium thiosulfate, and hemosorption applied 24 hours before the operation. Aldactone and sodium oxybutyrate are recommended in addition after decompression of the biliary tract. Such treatment in 162 patients reduced postoperative mortality to 4.4% in comparison with the control group in which it was 16%.

Topics: Animals; Antioxidants; Aprotinin; Cholestasis; Combined Modality Therapy; Glucose; Hemoperfusion; Humans; Postoperative Care; Preoperative Care; Sodium Oxybate; Spironolactone; Survival Rate; Thiosulfates; Time Factors; Trypsin Inhibitors

In the paper, the authors gave an analysis of some aspects of the metabolism in 90 patients, treated surgically for extrahepatic bile tract diseases (in 43 of them obstructive jaundice being noted), and the results of 34 experiments on white rats are summarized. Based on the conducted studies on acid-base balance, electrolyte metabolism and oxidative phosphorylation in hepatic mitochondria in the experiment under various kinds of anesthesia, some recommendations are given for including sodium oxybutyrate in anesthesia, the latter possessing a positive metabolic effect in patients with obstructive jaundice.

Topics: Acid-Base Equilibrium; Adult; Animals; Bilirubin; Cholestasis; Ether; Female; Humans; Male; Middle Aged; Mitochondria, Liver; Neuroleptanalgesia; Rats; Sodium Oxybate; Time Factors