title: Hemodynamic and biochemical changes in liver transplantation: A retrospective comparison of desflurane and total intravenous anesthesia by target-controlled infusion under auditory evoked potential guide.
abstract: OBJECTIVE
  Propofol-based total intravenous anesthesia (TIVA) has been used successfully for liver transplantation (LT) in recent years. However, there are few discourses in the literature which focus on the merits and weakness in perioperative management, biochemical changes, and postoperative recovery between TIVA and desflurane anesthesia (DES).
  
  
  METHODS
  We retrospectively compared the circumstances of liver transplantation recipients who had the surgery carried out under propofol-based TIVA or DES in the period from September 2007 to August 2010. Preoperative characteristics, date of intraoperative management, hemodynamic profiles, concentration of anesthetics, biochemical changes, and circumstances of postoperative recovery were retrieved from the hospital database for analysis.
  
  
  RESULTS
  We included 111 patients who received the surgery under either TIVA (n = 66) or DES (n = 45). Patient demographics, baseline laboratory data, operation time, and fluid management did not differ between the two groups. In comparison with the DES group, fewer patients had to be administered norepinephrine (21.2% vs. 42.2%; p = 0.020) in the TIVA group; moreover, the total dosage of norepinephrine was lower (0.003 ± 0.005 mg vs. 0.006 ± 0.008 mg; p = 0.012) in the TIVA group during liver reperfusion phase. Blood lactate level was higher in the DES group than in the TIVA group after the anhepatic phase. TIVA patients woke up faster than those in the DES group (54.0 ± 33.4 minutes vs. 95.0 ± 78.3 minutes; p = 0.034).
  
  
  CONCLUSIONS
  Our results suggest that propofol-based TIVA may provide better hemodynamics and microcirculation during the anhepatic phase in liver transplantation.
authors.affiliation: Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chueng-He
authors.initials: CH
authors.lastname: Lu
authors.affiliation: Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chun-Chang
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Yuan-Shiou
authors.initials: YS
authors.lastname: Huang
authors.affiliation: School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.affiliation: Division of General Surgery, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chung-Bao
authors.initials: CB
authors.lastname: Hsieh
authors.affiliation: Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC.
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.affiliation: Department of Anesthesiology, National Defense Medical Center and Tri-Service General Hospital, Taipei, Taiwan, ROC. Electronic address: aneswu@gmail.com.
authors.forename: Zhi-Fu
authors.initials: ZF
authors.lastname: Wu
mesh_terms: D000771:Anesthesia, Intravenous; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D007773:Lactates / Q000097:blood; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D015742:Propofol; D012189:Retrospective Studies
chemical_list: D007773:Lactates; D000077335:Desflurane; D007530:Isoflurane; D009638:Norepinephrine; D015742:Propofol
keywords: evoked potentials: auditory; infusions; intravenous: target-controlled infusion; liver transplantation; propofol; reperfusion injury