title: Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery?
abstract: BACKGROUND
  A recently published randomized control trial (RCT) showed a protection of the remnant liver from ischemia-reperfusion (I/R) injury by pharmacological pre-conditioning with a volatile anaesthetic in patients undergoing hepatic resection. Whether the continuous application of volatile anaesthetics (pharmacological conditioning) also protects against I/R injury is unknown.
  
  
  METHODS
  Consecutive patients undergoing liver resection with inflow occlusion from 2005-2007 were included in the trial. Two groups of anaesthesia regimens with either continuous application of the volatile anaesthetic sevoflurane (pharmacological conditioning) or continuous infusion of the intravenous (i.v.) anaesthetic propofol (control group) were compared. Endpoints were serum-peak-aspartate aminotransferase (AST)/ alanine aminotranferease (ALT) levels, length of stay (LOS) and intensive care unit (ICU) stays, and the occurrence of post-operative complications.
  
  
  RESULTS
  Two hundred and twenty-seven patients were included. Pharmacological conditioning did not protect the remnant liver from IR injury (adjusted difference for peak-AST:61.9 U/l, 95% confidence interval (CI): -151.7-275.4 U/l, P = 0.568; peak-ALT:136.1 U/l, 95% CI: -113.7-385.9 U/l, P = 0.284) nor reduce LOS (adjusted difference 0.9 days, 95% CI: -2.6-4.3 days, P = 0.622) or ICU stay (1.6 days, 95% CI: -0.2-3.3 days, P = 0.079), and was not associated with reduced complication rates (adjusted OR 1.12, 95% CI:0.6-2.3, P = 0.761) compared with the control group.
  
  
  CONCLUSIONS
  In this retrospective study, continuous volatile anaesthesia in liver resection does not provide protection of the remnant liver from IR injury compared with continuous i.v. anaesthesia.
authors.affiliation: Swiss HPB (Hepato-Pancreato-Biliary) Center, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ksenija
authors.initials: K
authors.lastname: Slankamenac
authors.forename: Stefan
authors.initials: S
authors.lastname: Breitenstein
authors.forename: Beatrice
authors.initials: B
authors.lastname: Beck-Schimmer
authors.forename: Rolf
authors.initials: R
authors.lastname: Graf
authors.forename: Milo A
authors.initials: MA
authors.lastname: Puhan
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D019610:Cytoprotection; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D007902:Length of Stay; D016014:Linear Models; D008107:Liver Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015742:Propofol / Q000008:administration & dosage*; D015427:Reperfusion Injury / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D000077149:Sevoflurane; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015415:Biomarkers; D008738:Methyl Ethers; D000077149:Sevoflurane; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D015742:Propofol