Abstract
BackgroundIt has been observed that patients with liver dysfunction need lower dose anesthetic compared patients with normal liver function. The minimum amount of volatile anesthetic to achieve an optimal depth of anesthesia for these patients is still unclear. In this study, Minimum alveolar concentration (MAC) of the sevoflurane was determined using an electric stimulation and the effect of severity of liver dysfunction on the MAC was observed in cirrhotic patients.MethodsThirty patients undergoing upper abdominal surgery were divided into the following groups: group N (normal liver function), group A (Child-Pugh grade A) and group B (Child-Pugh grade B-C). Neuropsychological tests were performed before surgery. We measured MACelectric (minimum alveolar concentration that prevents movement in response to an electric stimulation in 50 % of patients) of sevoflurane in cirrhotic patients with liver dysfunction using an electrical stimulation of 80 mA at 50 Hz, and analyzed factors that associated change of MAC.ResultsAccording to the neuropsychological tests, there were 7 and 4 patients with minimal hepatic encephalopathy in Groups B and A, respectively. MACelectric in cirrhotic patients with liver dysfunction decreased significantly compared to that in healthy liver patients (1.51 ± 0.16 vol. %, 1.33 ± 0.14 vol. % and 1.17 ± 0.13 vol. % in Group N, A and B, respectively), while MACelectric was comparable between the cirrhotic patients with different Child-Pugh grade. The Alanine Aminotransferase (ALT) and baseline values of bispectral index (BIS) were risk factors associated with the lowering of MACelectric (p < 0.05).ConclusionMACelectric of sevoflurane in cirrhotic patients was significantly lower than that of patients with a healthy liver. The severity of liver dysfunction had no effect on the MACelectric of sevoflurane in cirrhotic patients.Trial registrationThis study has been registered in the Chinese Clinical Trial Register in August 3, 2011 (No. ChiCTR-TRC-11001507).
Highlights
It has been observed that patients with liver dysfunction need lower dose anesthetic compared patients with normal liver function
Patients with Child-Pugh score over 6 required longer time to finish Number Connection Test A (NCT-A) and achieved lower Digit Symbol Test (DST) scores compared to patients with healthy liver (p < 0.05)
We demonstrate that Alanine aminotransferase (ALT) and bispectral index (BIS) were the risk factors associated the decrease of MACelectric
Summary
It has been observed that patients with liver dysfunction need lower dose anesthetic compared patients with normal liver function. The minimum amount of volatile anesthetic to achieve an optimal depth of anesthesia for these patients is still unclear. Minimum alveolar concentration (MAC) of the sevoflurane was determined using an electric stimulation and the effect of severity of liver dysfunction on the MAC was observed in cirrhotic patients. The minimum alveolar concentration (MAC) of anesthetic that prevents movement in 50 % of subjects in response to a noxious stimulus [1], is used to measure the capability of volatile anesthetics to immobilize patients who are exposed to noxious stimulation. We aimed to determine the MAC values (MACelectric) of sevoflurane in cirrhotic patients by using a supramaximal electric stimulation and evaluate the effect of severity of liver dysfunction on MACelectric. We provided data that shed light on the impact of liver dysfunction on the requirement of volatile anesthetics in humans
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