title: Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients.
abstract: Hepatic blood flow is reduced in a dose-related manner by all inhaled anesthetics now in use. We assessed hepatic function in elderly patients anesthetized with desflurane or sevoflurane. We measured the cytosolic liver enzyme alpha glutathione S-transferase (alpha GST), the formation of the lidocaine metabolite monoethylglycinexylidide (MEGX), and gastric mucosal tonometry-derived variables as sensitive markers of hepatic function and splanchnic perfusion. Thirty patients, 70 to 90 yr old, were allocated randomly to receive desflurane or sevoflurane anesthesia. Anesthetic exposure ranged from 2.1-4.5 minimum alveolar concentration hours. No significant changes in standard liver enzyme markers were seen throughout the study. In both anesthetic groups, tonometric measurements showed a significant decrease from baseline in regional PCO(2), regional to arterial difference in PCO(2), and intramucosal pH at 90 min after skin incision. alpha GST concentrations increased significantly in both groups (desflurane: median peak concentrations 5.8 microg/L [25th, 75th percentile 5.3 microg/L, 7.2 microg/L]; sevoflurane: 7.0 microg/L [5.8 microg/L, 7.3 microg/L]) without showing differences between both anesthetic groups. A return to baseline values in tonometric values and alpha GST levels was seen 24 h postoperatively. MEGX formation did not change significantly after surgery. Median MEGX concentrations postoperatively were 70.0 ng/mL (56.2 ng/mL, 102.0 ng/mL) and 70.0 ng/mL (60.0 ng/mL, 94.2 ng/mL) in the desflurane and sevoflurane groups, respectively. We conclude that, overall, liver function in elderly patients is well preserved during desflurane and sevoflurane anesthesia. Increased serum levels of alpha GST and changes of gastric tonometry-derived variables imply a reduction in splanchnic perfusion, leading to a temporary impairment of hepatocyte oxygenation.
  
  
  CONCLUSIONS
  We measured the lidocaine metabolite monoethylglycinexylidide, the cytosolic liver enzyme, alpha glutathione S-transferase, and gastric mucosal tonometry-derived variables to evaluate the effects of desflurane and sevoflurane on hepatic function in elderly patients. Liver function was well preserved, whereas increased alpha glutathione S-transferase levels and changes in tonometry-derived variables indicated a reduction in splanchnic blood flow and a temporary impairment of hepatocyte oxygenation for both anesthetics.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Akademisches Lehrkrankenhaus der Universität Mainz, Germany.
authors.forename: S W
authors.initials: SW
authors.lastname: Suttner
authors.forename: C C
authors.initials: CC
authors.lastname: Schmidt
authors.forename: J
authors.initials: J
authors.lastname: Boldt
authors.forename: I
authors.initials: I
authors.lastname: Hüttner
authors.forename: B
authors.initials: B
authors.lastname: Kumle
authors.forename: S N
authors.initials: SN
authors.lastname: Piper
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D000077335:Desflurane; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism; D005982:Glutathione Transferase / Q000378:metabolism; D006801:Humans; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D008012:Lidocaine / Q000031:analogs & derivatives / Q000493:pharmacokinetics; D008099:Liver / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D008012:Lidocaine; D000077335:Desflurane; D007530:Isoflurane; C001173:monoethylglycinexylidide; D005982:Glutathione Transferase