Reduced sevoflurane consumption in cirrhotic compared to non-cirrhotic patients undergoing major hepatic surgery

Abstract

BackgroundThere is evidence in literature that chronic hepatic patients need less anesthesia compared with healthy ones. Liver cirrhosis leads to a reduction in liver mass and hepatic blood flow with an effect on drug clearance and cardiovascular stability.AimTo evaluate sevoflurane consumption during entropy monitored general anesthesia in cirrhotic and non-cirrhotic patients during transition from consciousness to unconsciousness and throughout the procedure of major hepatic surgical procedures.Patients and methodsForty patients scheduled for major hepatic resection at the National Liver Institute, Menofiya University, Egypt, were studied prospectively and randomized into two equal groups. Group I (n. 20) cirrhotic patients (Child Pugh Grade A) with focal lesion, Group II (n. 20) healthy live liver donors undergoing major hepatectomies. Sevoflurane inhalational concentration was adjusted to achieve a state and response entropy of 40–60, and when RE increases 5–10 units above SE; more intravenous analgesics were given.ResultsMean (SD) Sevoflurane consumption in Group II showed higher consumption 23.5 (3.23) ml, compared to Group I 16 (2.19) ml. Mean (SD) sevoflurane consumption after 4 and 6 h from induction also showed a lower value in Group I 10.7(1.94), 9(1.22) ml, than in Group II 17.2(1.69), 14.1(2.19) ml, respectively. Mean (SD) end tidal sevoflurane concentration was lower in Group I 1.4(0.12) after 2 h from induction than in Group II 1.7(0.11). After 4 and 6 h from induction Group I demonstrated a lower value compared to Group II (P < 0.05.). Mean blood pressure, heart rate, urine output and CVP showed no significant changes during maintenance between the two groups.ConclusionThis study demonstrated that cirrhotic patients require less sevoflurane consumption and lower end-tidal concentration to maintain general anesthesia with entropy guidance. This could also have an important impact on the economic costs when applied on a larger scale.