The effects of propofol infusion on hepatic and pancreatic function and acid-base status in children undergoing craniotomy and receiving phenytoin.
BACKGROUND
In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-base status compared with baseline values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis.


METHODS
In this prospective clinical study, we measured the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg x kg(-1) x d(-1) phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1, 3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation (2nd and 4th h), just after extubation, and 1, 2, 6, and 12 h after extubation.


RESULTS
Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with baseline with a peak value on postoperative Day 1 and returned to normal values within a week. Base excess levels after extubation were significantly decreased compared with baseline. They were in the normal range, however, and returned to baseline values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4-6 mo after surgery.


CONCLUSIONS
Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clinical effect on the acid-base status or pancreas or liver enzymes.
Türe
Hatice
H
Departments of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey. hture@yeditepe.edu.t
Mercan
Arzu
A
Koner
Ozge
O
Aykac
Bora
B
Türe
Ugur
U
D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D000927:Anticonvulsants / Q000009:adverse effects*; D001663:Bilirubin / Q000097:blood; D001784:Blood Gas Analysis; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007677:Kidney Function Tests; D008099:Liver / Q000201:enzymology; D008111:Liver Function Tests; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010672:Phenytoin / Q000009:adverse effects*; D015742:Propofol / Q000009:adverse effects*; D015173:Supratentorial Neoplasms / Q000601:surgery; D014280:Triglycerides / Q000097:blood
D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D000927:Anticonvulsants; D014280:Triglycerides; D010672:Phenytoin; D009020:Morphine; D001663:Bilirubin; D015742:Propofol