Effect of anesthesia factor on kidney injury in pediatric patients undergoing living donor liver transplantation: a comparison of sevoflurane- versus propofol-based anesthesia

Abstract

Objective To compare the effects of sevoflurane- and propofol-based anesthesia on kidney injury in pediatric patients undergoing living donor liver transplantation. Methods Eighty pediatric patients of both sexes, aged 5-15 months, weighing 5.5-10.0 kg, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective living donor liver transplantation, were divided into 2 groups (n=40 each) using a random number table method: sevoflurane-based anesthesia group (group S) and propofol-based anesthesia (group P). Sevoflurane was inhaled, and the end-tidal concentration was maintained at 1.0%-3.0% in group S. Propofol 9-15 mg·kg-1·h-1 was intravenously infused in group P. Fentanyl 1-3 μg/kg was intermittently injected, and cisatracurium 1-2 μg·kg-1·min-1 was intravenously infused in two groups.Bispectral index value was maintained at 40-60.Immediately before skin incision (T1), at 30 min of anhepatic phase (T2), at 3 h of neohepatic phase (T3), at 24 h after operation (T4) and at day 3 after surgery (T5), blood samples from the central vein and urine specimens were collected for determination of the levels of neutrophil gelatinase-associated lipocalin and cystatin C in serum and urine by enzyme-linked immunosorbent assay.The urine volume, requirement for dopamine and occurrence of hypotension and myocardial ischemia were recorded during surgery. Results Compared with group P, the levels of neutrophil gelatinase-associated lipocalin and cystatin in serum and urine were significantly decreased at T3-5(P 0.05). Conclusion Compared with propofol-based anesthesia, kidney injury is attenuated in pediatric patients undergoing living donor liver transplantation under sevoflurane-based anesthesia. Key words: Acute kidney injury; Anesthetics, inhalation; Propofol; Liver transplantation; Child