Volatile anesthetics might be more beneficial than propofol for postoperative liver function in cirrhotic patients receiving hepatectomy.
Hepatic inflow occlusion during the liver surgery may result in a transient ischemia period followed by reperfusion, and may initiate liver injury and lead to postoperative liver dysfunction. Especially in cirrhotic patients, the tolerance time of ischemia is much shorter and the outcome would be worse. Recently, clinical trials had proved that volatile anesthetics rather than propofol can protect myocardial cells from ischemia reperfusion (IR) injury in cardiac surgery. Meanwhile, animal studies had revealed that volatile anesthetics could induce some endogenous protective molecules in the liver such as hypoxia induced factor-1 (HIF-1), heme oxygenase (HO) enzyme system and inducible nitric oxide synthase (iNOS), which make the volatile anesthetics posing the extraordinary anti-oxidative, anti-inflammatory, anti-apoptotic, and vasodilatory characteristics. However, there is still lack of trials to compare the postoperative outcomes such as liver function in cirrhotic patients undergoing liver surgery with inflow occlusion between volatile anesthetics and propofol anesthesia. Hence we hypothesize that with its anti-IR injury characteristics, volatile anesthetics might be the more appropriate choice in cirrhotic patients undergoing liver surgery with occlusion.
Tao
K M
KM
Department of Anesthesia and Intensive Care, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China.
Yang
L Q
LQ
Liu
Y T
YT
Tao
Y
Y
Song
J C
JC
Wu
F X
FX
Yu
W F
WF
D018685:Anesthetics, Inhalation / Q000494:pharmacology* / Q000627:therapeutic use; D000077335:Desflurane; D006419:Heme Oxygenase (Decyclizing) / Q000378:metabolism; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D051793:Hypoxia-Inducible Factor 1 / Q000378:metabolism; D007530:Isoflurane / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000378:metabolism; D008103:Liver Cirrhosis / Q000601:surgery*; D008738:Methyl Ethers / Q000494:pharmacology / Q000627:therapeutic use; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism; D015742:Propofol; D015427:Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D000077149:Sevoflurane; D014835:Volatilization
D018685:Anesthetics, Inhalation; D051793:Hypoxia-Inducible Factor 1; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D052247:Nitric Oxide Synthase Type II; D006419:Heme Oxygenase (Decyclizing); D015742:Propofol