title: Cerebral protective effect of nicorandil premedication on patients undergoing liver transplantation.
abstract: BACKGROUND
  Neurological injury is a common complication in the early period after liver transplantation, posing an enormous obstacle to treatment efficiency and patient survival. Nicorandil is a mitochondrial ATP-sensitive potassium channel (mitoKATP) opener. It has been reported to be effective in reducing brain injury in recent studies. However, it is still unclear whether nicorandil has cerebral protective effect in patients undergoing liver transplantation.
  
  
  METHODS
  Fifty patients scheduled for liver transplantation were randomly divided into a nicorandil group (group N) (n=25), in which patients received 10 mg nicorandil through a nasogastric tube 30 minutes before induction of anesthesia, and a control group (group C) (n=25) who received 10 mL normal saline. The Mini-Mental State Examination (MMSE) was performed before anesthesia (day 0), and on days 3 and 7 after surgery. Blood samples were obtained before induction of anesthesia (T1), and at 12 (T2) and 36 hours (T3) after surgery for determination of serum neuron-specific enolase (NSE) and S100β protein (S100β) concentrations.
  
  
  RESULTS
  During surgery, 5 patients in each group were eliminated due to severe reperfusion or renal insufficiency. Therefore, 20 patients remained in each group. The MMSE scores after operation were significantly lower than those before operation in group C. However, there was no difference at days 3 and 7 compared with day 0 in group N. Serum NSE concentrations after surgery were significantly higher than baseline (at T1) in both groups, except at T3 in group N. Serum S100β concentration after surgery was significantly higher than baseline (at T1) in both groups. The MMSE scores at days 3 and 7 in group N were significantly higher than those in group C. The concentrations of serum NSE and S100β at T2 and T3 in group N were significantly lower than those in group C.
  
  
  CONCLUSIONS
  Oral nicorandil, as a premedication before liver transplantation, improves postoperative MMSE scores. It also attenuates the increase of NSE and S100β in blood, indicating its cerebral protective effect.
authors.affiliation: Department of Anesthesiology, Shanghai First People's Hospital, Medical College, Shanghai Jiaotong University, Shanghai 200080, China.
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Xia
authors.forename: Zheng-Ping
authors.initials: ZP
authors.lastname: Wang
authors.forename: Ya-Chun
authors.initials: YC
authors.lastname: Zhou
authors.forename: Tao
authors.initials: T
authors.lastname: Yan
authors.forename: Shi-Tong
authors.initials: ST
authors.lastname: Li
mesh_terms: D000284:Administration, Oral; D001930:Brain Injuries / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007361:Intelligence Tests; D054086:KATP Channels / Q000819:agonists / Q000187:drug effects; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D009414:Nerve Growth Factors / Q000097:blood; D020108:Nicorandil / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010751:Phosphopyruvate Hydratase / Q000097:blood; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology* / Q000517:prevention & control*; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D016896:Treatment Outcome
chemical_list: D054086:KATP Channels; D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; D020108:Nicorandil; D010751:Phosphopyruvate Hydratase