Comparing the Effect of Propofol and Sevoflurane on Hemodynamics and Coagulation Status during Liver Transplant Anesthesia and Hepatic and Renal Function of the Patients after Liver Transplant

Propofol and sevoflurane during liver transplant…

  • Atabak Najafi 1Department of Anesthesiology and Critical Care, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran AND 2Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Zahid Hussain Khan Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesiology and Critical Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
  • Salah Faaez Abdulnabi Department of Anesthesia, School of Allied Medical Sciences, International Campus, Tehran University of Medical Sciences, Tehran, Iran.
  • Zinat Mohammadpour Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Gilda Barzin Liver Transplantation Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
  • Jayran Zebardast Virtual School, Tehran University of Medical Sciences, Tehran, Iran.
Keywords: Liver transplantation, Propofol, Sevoflurane, Hemodynamics, Coagulation status

Abstract

Background: At present, no documented anesthetic technique exists for use in liver transplant surgery. Presence of some controversies in anesthesia plan led us to compare effects of inhaled and intravenous anesthetics in liver transplant surgery.

Methods: All those brain dead patients who met the criteria of organ donation were included in the study. The donor's liver is matched with the recipient according to our liver transplant protocols and assigned consecutively to the recipients. In this study 78 patients who met the inclusion criteria, were divided into two groups.

All patients in group 1 were anesthetized with inhalation of sevoflurane and patients in group 2 were anesthetized with the IV injection of propofol. Percent of sevoflurane in inhaled gases and IV infusion dose of propofol was determined by a BIS guide to keep BIS between 40 and 45. Patients were monitored by NIBP, ECG, CO – Oximetry and BIS before and during induction of anesthesia. An arterial line from radial artery and Swan–Ganz–Catheter from right internal jugular vein were inserted for all patients.

Results: Mean of PCO2, PO2 and HCO3 were different between 2 groups (p=<0.05) and were higher in propofol group. Also, mean of Na and K were different in both groups and were higher in sevoflurane group, and no other significant differences found.

Conclusion: The results showed that the effect of propofol and sevoflurane on hemodynamics, coagulation status during liver transplant anesthesia, and hepatic and renal function of the patients after liver transplant is the same.

References

1. Schilsky ML, Moini M. Advances in liver transplantation allocation systems. World J Gastroenterology. 2016; 22(10):2922.
2. Londoño JF, Agudelo Y, Guevara G, Cardona D. Clinical and Demographic Factors Associated with Survival Following Liver Transplantation in Patients over 14 Years of Age at the Hospital Universitario de San Vicente Fundación from 2002 to 2013. Revista Colombiana de Gastroenterologia. 2016; 31(3):208-15.
3. Mazza G, De Coppi P, Gissen P, Pinzani M. Hepatic regenerative medicine. J Hepatol. 2015; 63(2):523-4.
4. Estival J, Debourdeau P, Zammit C, Teixeira L, Guerard S, Colle B. Spontaneous portal vein thrombosis associated with acute cytomegalovirus infection in an immunocompetent patient. Presse med. 2001; 30(38):1876-8.
5. Keay KA, Crowfoot LJ, Floyd NS, Henderson LA, Christie MJ, Bandler R. Cardiovascular effects of microinjections of opioid agonists into theDepressor Region'of the ventrolateral periaqueductal gray region. Brain Res. 1997; 762(1-2):61-71.
6. Hosseinzadeh H, Golzari SE, Torabi E, Dehdilani M. Hemodynamic changes following anesthesia induction and LMA insertion with propofol, etomidate, and propofol+ etomidate. J Cardiovasc Thorac Res. 2013; 5(3):109-12.
7. Dewhirst E, Lancaster C, Tobias JD. Hemodynamic changes following the administration of propofol to facilitate endotracheal intubation during sevoflurane anesthesia. Int J Clin Exp Med. 2013; 6(1): 26–29.
8. Lu C-H, Yeh C-C, Huang Y-S, Lee M-S, Hsieh C-B, Cherng C-H, et al. Hemodynamic and biochemical changes in liver transplantation: A retrospective comparison of desflurane and total intravenous anesthesia by target-controlled infusion under auditory evoked potential guide. Acta Anaesthesiol Taiwan. 2014; 52(1):6-12.
9. Clavien P-A, Yadav S, Sindram D, Bentley RC. Protective effects of ischemic preconditioning for liver resection performed under inflow occlusion in humans. Ann Surg. 2000; 232(2):155-62.
10. Clavien P-A, Selzner M, Rüdiger HA, Graf R, Kadry Z, Rousson V, et al. A prospective randomized study in 100 consecutive patients undergoing major liver resection with versus without ischemic preconditioning. Ann Surg. 2003; 238(6):843.
11. Petrowsky H, McCormack L, Trujillo M, Selzner M, Jochum W, Clavien P-A. A prospective, randomized, controlled trial comparing intermittent portal triad clamping versus ischemic preconditioning with continuous clamping for major liver resection. Ann Surg. 2006; 244(6):921.
12. Sahin S, Cinar S, Paksoy I, Sut N, Oba S. Comparison between low flow sevoflurane anesthesia and total intravenous anesthesia during intermediate-duration surgery: effects on renal and hepatic toxicity. Hippokratia. 2011; 15(1):69-74.
13. Alonso MB, Gajate ML, García SJ, Martín MA, Moreno BR, Arribas PP, et al. Retrospective comparative study between sevoflurane and propofol in maintaining anaesthesia during liver transplant: Effects on kidney and liver function. Rev Esp Anestesiol Reanim. 2012; 59(5):237-43.
14. Song J, Sun Y, Yang L, Zhang M, Lu Z, Yu W. A comparison of liver function after hepatectomy with inflow occlusion between sevoflurane and propofol anesthesia. Anesth Analg. 2010; 111(4):1036-41.
15. Yoon JH, Cho SH, Kim CS, Ahn KR, Kwon JH, Kang KS, et al. Comparisons of propofol, enflurane, sevoflurane, and desflurane anesthesia in laparoscopic cholecystectomy on postoperative liver enzyme levels. Korean J Anesthesiology. 2005; 49(1):18-24.
16. Oh SW, Koo GH, Kim SJ, Woo YC. Comparison of propofol with enflurane anesthesia in laparoscopic cholecystectomy for the change of liver function. Korean J Anesthesiology. 1999; 36(2):279-85.
17. Kim JW, Kim JD, Yu SB, Ryu SJ. Comparison of hepatic and renal function between inhalation anesthesia with sevoflurane and remifentanil and total intravenous anesthesia with propofol and remifentanil for thyroidectomy. Korean J Anesthesiology. 2013; 64(2):112-6.
Published
2019-09-21
How to Cite
1.
Najafi A, Khan ZH, Abdulnabi SF, Mohammadpour Z, Barzin G, Zebardast J. Comparing the Effect of Propofol and Sevoflurane on Hemodynamics and Coagulation Status during Liver Transplant Anesthesia and Hepatic and Renal Function of the Patients after Liver Transplant. Arch Anesth & Crit Care. 5(4):128-32.
Section
Research Article(s)