Abstract
Background and aim: The choice of anaesthetic agents is important for cirrhotics undergoing liver resection. Aim is to compare Target Controlled Infusion (TCI) Propofol-Fentanyl versus Desflurane (Des) on recovery, hemodynamics monitored with Transoesophageal Doppler (TED), the effect on hepatocellular, kidney functions and economics. Patients and methods: Prospective randomized controlled study, 50 patients (Child A) divided equally. In (Des) group induction with fentanyl (1microgram/kg), propofol (2 mg/kg) and rocuronium (1 mg/kg) and maintenance with Desflurane. In (TCI) group the Propofol blood target concentration (Ct) for induction was set at 4 μg/min and Fentanyl infusion was set at 3 μg/kg for 30 seconds , 2 μg/kg/h for 30 min, 1.5 μg/kg/h from 31-150 min, and 1 μg/kg/h until 30 min before end. Both propofol and fentanyl maintained with Navigator pharmacokinetic software and Entropy guidance. TED, urinary micro albuminurea (microalb), blood Glutathione-S-transferase (GST) were monitored. Results: Extubation time prolonged with TCI vs. Des (15.2 ± 2.6 vs. 9.7 ± 1.5 min respectively, (P 0.05), (Microalb. 17.7 ± 2.5 vs. 18.64 ± 1.19, (μgm/ml) respectively, P>0.05). Des more economic than TCI (33.5 ± 8.2 vs. 69.1 ± 8.1 US Dollars), (P< 0.05) respectively during same surgical time and with comparable hemoglobin concentrations. Conclusion: Recovery was enhanced better with Desflurane. TED monitoring demonstrated a significant preservation of SVR and MABP post-resection with Des vs. TCI. Neither was superior to the other with respect to liver and kidney functions. Further studies on a larger scale are recommended.
Highlights
Transoesophageal Doppler (TED) monitoring demonstrated a significant preservation of Systemic vascular resistance (SVR) and MABP post-resection with Des vs. Target Controlled Infusion (TCI)
Hepatocellular carcinoma (HCC) is not uncommon in patients with chronic liver disease resulting from infection with hepatitis C virus (HCV) [1,2]
Hemodynamic results were in favour with Desflurane compared to TCI Propofol/Fentanyl; this could be attributed to the better preservation of the systemic vascular resistance with desflurane when used to maintain the general anaesthetic status in contrast to propofol
Summary
Hepatocellular carcinoma (HCC) is not uncommon in patients with chronic liver disease resulting from infection with hepatitis C virus (HCV) [1,2]. In Egypt, between 1993 and 2002, there was an almost twofold increase in HCC amongst chronic liver patients [3]. Few studies were designed to address this issue in cirrhotic patients with use of the minimal invasive transoesophageal Doppler to monitor these perioperative haemodynamic changes [5]. Primary goal is to compare Targetcontrolled infusion of propofol-fentanyl versus desflurane based anesthesia for cirrhotic patients undergoing liver resection as regards recovery, hemodynamic parameters, hepatic and renal affection with a secondary goal to assess the economic impact. Aim is to compare Target Controlled Infusion (TCI) Propofol-Fentanyl versus Desflurane (Des) on recovery, hemodynamics monitored with Transoesophageal Doppler (TED), the effect on hepatocellular, kidney functions and economics
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