Comparison of myocardial injury in pediatric patients undergoing living-donor liver transplantation performed under propofol- versus sevoflurane-based anesthesia

Abstract

Objective To compare the severity of myocardial injury in pediatric patients undergoing living-donor liver transplantation (LDLT) performed under propofol- versus sevoflurane-based anesthesia. Methods Forty American Society of Anesthesiologists physical status Ⅲ or Ⅳ pediatric patients of both sexes, aged 5-13 months, weighing 5-12 kg, scheduled for elective LDLT under general anesthesia, were divided into 2 groups (n=20 each) using a random number table: propofol-based anesthesia group (group P) and sevoflurane-based anesthesia group (group S). Anesthesia was induced with intravenously injected midazolam 0.15 mg/kg, fentanyl 2-5 μg/kg and cisatracurium 0.15 mg/kg.Anesthesia was maintained by IV infusion of propofol 9-15 mg·kg-1·h-1 (in group P), continuous inhalation of 2.6%-4.0% sevoflurane (in group S), intermittent IV boluses of fentanyl 1-3 μg/kg and IV infusion of cisatracurium 1-2 μg·kg-1·min-1.At 5 min of anesthesia induction, 30 min of anhepatic phase, 3 h of neohepatic stage and the end of surgery, blood samples were taken from the central vein for determination of concentrations of cardiac troponin I and creatine kinase-MB in serum and concentrations of tumor necrosis factor-alpha, interleukin-6 and high-mobility group box 1 protein in serum (by enzyme-linked immunosorbent assay). The occurrence of adverse cardiovascular events (hypertension or hypotention, myocardial ischemia and ventricular premature beat) was recorded during surgery. Results There was no significant difference in concentrations of tumor necrosis factor-alpha, interleukin-6, high-mobility group box 1 protein, cardiac troponin I and creatine kinase-MB in serum at each time point or incidence of adverse cardiovascular events between the two groups (P>0.05). Conclusion The severity of myocardial injury is comparable in pediatric patients undergoing LDLT performed under propofol- versus sevoflurane-based anesthesia. Key words: Anesthetics, inhalation; Propofol; Liver transplantation; Myocardial reperfusion injury; Child