title: DESFLURANE COMPARED TO SEVOFLURANE FOR CIRRHOTIC PATIENTS UNDERGOING MAJOR LIVER RESECTION. A RANDOMIZED CONTROL STUDY.
abstract: BACKGROUND
  Major liver resection is associated with haemodynamic, hepatic and renal changes as a result of the procedure.
  
  
  OBJECTIVE
  To compare Desflurane (D) versus Sevoflurane (S) on hepatic, renal functions, haemodynamics and perioperative course for cirrhotic patients undergoing major liver resection.
  
  
  METHODS
  A prospective randomized control study with 50 patients (Child A) (D, n = 25 and S, n = 25). End tidal D or S adjusted with Entropy (40-60). Haemodynamics monitored with invasive blood pressure and trans-oesophageal Doppler (TED). Liver and kidney function tests, blood Glutathione-S-transferase (GST), urinary microalbuminuria (Microalb) were assayed. Extubation time and anaesthetic consumption were recorded.
  
  
  RESULTS
  Systemic vascular resistance (SVR) post-resection and stroke volume of D vs S were 835.04 ± 12.02 vs 778.16 ± 11.97 dyn.sec.cm(-5), P < 0.01, and 85.72 ± 2.95 vs 76.16 ± 6.52 ml, P < 0.01 respectively. Doppler corrected flow time (FTc) between groups were comparable (P > 0.05). No difference post-operatively regarding hepatic and renal functions, and urine Microalb (14.76 ± 3.95 vs l4.24 ± 8.65 µg/ml, P = 0.78), but a statistically difference was found with GST (0.046 ± [symbols: see text], vs 0.043 ± [symbols: see text] IU/ml, P < 0.01). Despite a higher D consumption (73 ± 17 vs 64 ± 22 ml, P = 0.102), cost in Egyptian pounds (LE) was lower with D (141.14 ± 32.90 vs 320.60 ± 114.01, LE, P < 0.01). Extubation time and ICU stay with D vS (4.52 ± 2 vs 7.72 ± 2 min, P < 0.01) and (1.40 0.50 vs 1.64 ± 0.48, days P = 0.09) respectively.
  
  
  CONCLUSIONS
  Neither D nor S were clinically superior to the other with respect to liver and kidneys functions, but D was found to preserve better the haemodynamic parameters and enhance recovery at a lower cost.
authors.forename: M
authors.initials: M
authors.lastname: Abou Hussein
authors.forename: F
authors.initials: F
authors.lastname: Mahmoud
authors.forename: R
authors.initials: R
authors.lastname: Beltagy
authors.forename: A
authors.initials: A
authors.lastname: Hasanin
authors.forename: K
authors.initials: K
authors.lastname: Yassen
authors.forename: A
authors.initials: A
authors.lastname: Attar
mesh_terms: D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D000077335:Desflurane; D004311:Double-Blind Method; D017548:Echocardiography, Transesophageal; D005260:Female; D005982:Glutathione Transferase / Q000097:blood; D006439:Hemodynamics; D006498:Hepatectomy; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D005982:Glutathione Transferase