title: Hepatic cytoprotective effect of ischemic and anesthetic preconditioning before liver resection when using intermittent vascular inflow occlusion: a randomized clinical trial.
abstract: BACKGROUND
  Ischemic preconditioning (IPC) and anesthetic preconditioning (APC) have been reported to attenuate ischemia-reperfusion (IR) injury after liver resection under continuous inflow occlusion. This study evaluates whether these strategies enhance hepatic protection of remnant liver against IR after liver resection with intermittent clamping (INT).
  
  
  METHODS
  A total of 106 patients without underlying liver disease and submitted to liver resection using INT were randomized into 3 groups: IPC (10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection), APC (sevoflurane administration for 20 minutes before liver transection), and INT (no preconditioning). Patients were also stratified according to the extent of the hepatectomy. Cytoprotection was evaluated by comparing hepatocyte and endothelial dysfunction markers, apoptosis, histologic lesions, and postoperative outcome.
  
  
  RESULTS
  No differences were observed in preoperative chemotherapy and steatosis, total warm ischemia time, operative time, or blood loss. Kinetics of transaminases (aspartate aminotransferase, P = .137; alanine aminotransferase, P = .616), bilirubin (P = .980), and hyaluronic acid increase (P = .514) revealed no differences. Significant apoptosis was present in 40% of patients, mild-to-moderate leukocyte infiltration and steatosis in 45% and 55%, respectively, and mild sinusoidal congestion in 65%, with a similar distribution in the 3 groups. When patients were stratified by major versus minor resections, no differences were observed in any of the variables studied. Postoperative clinical outcomes were also similar.
  
  
  CONCLUSIONS
  These results suggest that these protocols of IPC and APC used in this study do not provide better cytoprotection from IR when INT is used.
authors.affiliation: Department of Anesthesiology, Hospital Universitari Mútua Terrassa, Terrassa, Spain. Electronic address: aurorarc1@gmail.com.
authors.forename: Aurora
authors.initials: A
authors.lastname: Rodríguez
authors.affiliation: Department of Anesthesiology, Liver Surgery and Liver Transplant Unit, Hospital Clinic, Barcelona University, Barcelona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Taurà
authors.affiliation: Department of Surgery, Liver Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Maria I
authors.initials: MI
authors.lastname: García Domingo
authors.affiliation: Department of Surgery, Liver Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Eric
authors.initials: E
authors.lastname: Herrero
authors.affiliation: Department of Surgery, Liver Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Camps
authors.affiliation: Department of Histopathology, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Forcada
authors.affiliation: Department of Anesthesiology, Fundació Puigvert, Barcelona, Spain.
authors.forename: Sergi
authors.initials: S
authors.lastname: Sabaté
authors.affiliation: Department of Surgery, Liver Surgery, Hospital Universitari Mútua Terrassa, Terrassa, Spain.
authors.forename: Esteve
authors.initials: E
authors.lastname: Cugat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D053148:Caspase 3 / Q000378:metabolism; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D008099:Liver / Q000098:blood supply / Q000293:injuries / Q000503:physiopathology; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D052247:Nitric Oxide Synthase Type II / Q000235:genetics; D012333:RNA, Messenger / Q000235:genetics / Q000378:metabolism; D015427:Reperfusion Injury / Q000517:prevention & control*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D012333:RNA, Messenger; D000077149:Sevoflurane; C496319:NOS2 protein, human; D052247:Nitric Oxide Synthase Type II; C505407:CASP3 protein, human; D053148:Caspase 3