In the present article, cerebral autoregulation capacity was In acute liver failure, massive hepatic necrosis may evaluated in patients with FHF before and after improvement result in impaired regulation of cerebral blood flow of liver function, either spontaneous or following liver trans-(CBF), development of encephalopathy, and cerebral plantation. The patients were followed daily to establish when edema. In 10 consecutive patients with fulminant hethe CBF autoregulation was restored, and if CBF autoregulapatic failure (FHF), CBF autoregulation was found to tion was re-established before complete alleviation of HE. be absent, as transcranial Doppler mean flow velocity (V mean ) in the middle cerebral artery increased from 49 (27-59) to 69 (49-92) cm/s (P Γ΅ .05) during a 30-(28-34) mm PATIENTS AND METHODS Hg rise in mean arterial pressure (MAP). In 7 patients, Ten consecutive patients (median age, 39 years; range, 25-50 restoration of CBF autoregulation was shown within 48 years) with FHF were included in the study. Clinical and laboratory
(24-120) hours after spontaneous hepatic recovery or data for each patient are listed in Table 1. All patients were comatose liver transplantation, before complete alleviation of hegrade four, with preserved pupillary response to light during the patic encephalopathy (HE). The extraordinarily rapid entire study. None of the patients were hypoglycemic or treated with restoration of CBF autoregulation in patients with FHF sedatives before the appearance of HE.
following re-establishment of liver function is unique
No patient received mannitol, thiopenthal, muscle relaxants, or compared with other conditions affecting the CBF autobenzodiazepines during the study. N-Acetylcysteine was adminis- tered to patients with acetaminophen intoxication according to stanregulation, indicating a close connection between liver dard recommendations.
function and regulation of cerebral circulation. Because
A catheter was inserted into a radial artery for blood sampling
CBF autoregulation was restored after initial alleviation
and monitoring of mean arterial pressure (MAP) (Baxter transducer,
Results
The median number of measurements correlating V mean Abbreviations: HE, hepatic encephalopathy; CBF, cerebral blood flow; FHF, fulminant with MAP in each patient was 14 (range, 12-24), and the hepatic failure; MAP, mean arterial pressure; Vmean, mean flow velocity.