Toprak H I, Şahin T, Aslan S, Karahan K, Şanli M, Ersoy M Ö
Department of Anesthesiology, Medical School of Inonu University, Malatya, Turkey.
Transplant Proc. 2012 Jul-Aug;44(6):1635-9. doi: 10.1016/j.transproceed.2012.05.047.
We compared the effect of two inhalation anesthetics desflurane and isoflurane on postoperative hepatic and renal functions as well as coagulation profiles in living donors undergoing right hepatectomy. This study was performed on 80 patients who were randomly allocated to group D (desflurane, n = 40) or group I (isoflurane, n = 40) after Faculty Ethics Committee approval. After induction, isoflurane or desflurane was used with air/oxygen for anesthetic maintenance. The isoflurane or desflurane concentration was set at one minimum alveolar concentration (MAC). Remifentanil was infused for analgesia as well as cisatracurium. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), international normalized ratio (INR), albumin, total bilirubin, blood urea nitrogen, creatinine, platelet count, and hemoglobin levels were analyzed preoperatively at end of the operation, and on postoperative days (PODs) 1, 2, 3, 5, 7, and 30. Both AST and ALT differed significantly and continually except on POD 30. AST showed significant elevations from the end of the operation to POD 2 and ALT, from the end of the operation to POD 5 in group I compared with group D. INR was significantly higher from the end of the operation to POD 3 in group I and to POD 2 in group D. At the end of the operation as well as on POD 1 and POD 2, INR was significantly increased in group I compared with group D. Albumin level was significantly lower at the end of the operation in both groups, but it was not different. No patient developed hepatic or renal failure. Our study showed better postoperative hepatic tests and INR using desflurane than isoflurane at equivalent doses of 1 MAC in living donors undergoing right hepatectomy.
我们比较了两种吸入麻醉剂地氟烷和异氟烷对接受右半肝切除术的活体供肝者术后肝功能、肾功能以及凝血指标的影响。本研究经学院伦理委员会批准后，对80例患者进行，这些患者被随机分为D组（地氟烷，n = 40）或I组（异氟烷，n = 40）。诱导后，使用异氟烷或地氟烷与空气/氧气混合进行麻醉维持。异氟烷或地氟烷浓度设定为一个最低肺泡有效浓度（MAC）。输注瑞芬太尼用于镇痛以及顺式阿曲库铵。在术前、手术结束时以及术后第1、2、3、5、7和30天分析天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、国际标准化比值（INR）、白蛋白、总胆红素、血尿素氮、肌酐、血小板计数和血红蛋白水平。除术后第30天外，AST和ALT均有显著且持续的差异。与D组相比，I组中AST从手术结束至术后第2天显著升高，ALT从手术结束至术后第5天显著升高。I组中从手术结束至术后第3天INR显著高于D组，D组至术后第2天INR显著高于I组。在手术结束时以及术后第1天和第2天，I组的INR显著高于D组。两组在手术结束时白蛋白水平均显著降低，但无差异。没有患者发生肝或肾衰竭。我们的研究表明，在接受右半肝切除术的活体供肝者中，使用等效剂量1 MAC的地氟烷比异氟烷术后肝功能检查和INR情况更好。
