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Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery?


Slankamenac, Ksenija; Breitenstein, Stefan; Beck-Schimmer, Beatrice; Graf, Rolf; Puhan, Milo A; Clavien, Pierre-Alain (2012). Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery? HPB, 14(12):854-862.

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.
CONCLUSION: 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.

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.
CONCLUSION: 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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Visceral and Transplantation Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic and Policlinic for Internal Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2012
Deposited On:29 Jan 2013 14:47
Last Modified:07 Dec 2017 18:28
Publisher:Wiley-Blackwell
ISSN:1365-182X
Publisher DOI:https://doi.org/10.1111/j.1477-2574.2012.00570.x
PubMed ID:23134188

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