[Effects of esmolol- and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery].
BACKGROUND
Controlled hypotension (CH) is an established method to reduce intraoperative bleeding. The aim of the study was to investigate the influence of CH induced by sodium nitroprusside (SN) or esmolol on hepatocellular integrity.


METHODS
Prospective, randomized, controlled study. 45 patients scheduled for elective endonasal sinus surgery were allocated to one of the following three groups: 1. SN-group (n = 15): CH induced by SN. 2. Esmolol-group: CH induced by esmolol. In both groups mean arterial pressure was kept between 50-55 mmHg. 3. Control group (n = 15): no hypotension was performed (MAP > 70 mmHg). The cytosolic liver enzyme alpha-glutathione S-transferase (alpha-GST) and standard liver enzymes (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltransferase) were measured at the following timepoints: preoperative (T0), at the end of surgery (T1), 2 h (T2), 24 h (T3) and 48 h (T4) postoperatively.


RESULTS
alpha-GST concentrations were significantly higher in patients receiving CH (SN: 5.9 +/- 3.4; Esmolol: 6.5 +/- 2.8 microg/L) in comparison with controls (2.5 +/- 1.4 microg/L) at T1. Already at T2 there were no significant differences between the three groups. Standard liver enzymes showed a similar course in all groups.


CONCLUSIONS
The small but significant increase of alpha-GST in both hypotension groups suggests that hypotension induces a mild damage of hepatocellular integrity.
Piper
S N
SN
Klinik für Anaesthesiologie und Operative Intensivmedizin, Klinikum Ludwigshafen, Ludwigshafen am Rhein. swen.n.piper@t-online.de
Haisch
G
G
Kumle
B
B
Walz
G A
GA
Breining
T
T
Mattinger
P
P
Boldt
J
J
D000319:Adrenergic beta-Antagonists; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000959:Antihypertensive Agents; D001219:Aspartate Aminotransferases / Q000097:blood; D004311:Double-Blind Method; D004798:Enzymes / Q000097:blood; D005260:Female; D005982:Glutathione Transferase / Q000097:blood; D006439:Hemodynamics / Q000187:drug effects; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007023:Hypotension, Controlled; D008099:Liver / Q000187:drug effects / Q000502:physiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009599:Nitroprusside; D010256:Paranasal Sinuses / Q000601:surgery*; D011412:Propanolamines; D011446:Prospective Studies
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004798:Enzymes; D006454:Hemoglobins; D011412:Propanolamines; D009599:Nitroprusside; D005982:Glutathione Transferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; C036604:esmolol