Total Intravenous Anaesthesia Regimen Research Articles

Dexmedetomidine versus fentanyl in intraoperative neuromuscular monitoring using propofol based total intravenous anesthesia regimen in kyphoscoliosis correction surgery

BackgroundIntraoperative neuromuscular monitoring (IONM) is used to reduce the risk of postoperative neurological deficit in patients undergoing kyphoscoliosis correction surgery. Somatosensory evoked potentials (SSEPs) are among the several techniques developed by neurophysiologists to increase the sensitivity of intraoperative monitoring. We administered total intravenous anesthesia (TIVA) to 20 patients undergoing kyphoscoliosis deformity correction surgeries: group A: propofol and dexmedetomidine and group B: propofol and fentanyl. The primary objective of our study was to compare the effect of dexmedetomidine and fentanyl on intraoperative hemodynamic parameters and their interference with SSEP’s readings. The secondary objective was to assess the total intraoperative requirement of inhalational anesthetic agents, quality of surgical field, and the cost-effectiveness of either regimen.ResultsIntraoperative hemodynamic stability, analgesia, surgical field, and cost-effectiveness (due to reduced requirement of sevoflurane) were better with dexmedetomidine than fentanyl. SSEPs were successfully recorded with both the drugs while the requirement of inhalation anesthetic agents was significantly reduced in the dexmedetomidine group than in the fentanyl group. There were no injuries while recording SSEPs. The latency and amplitude of SSEPs were maintained throughout either group. No intraoperative awakening or awareness was noted (bispectral index was maintained in the range of 40 to 60). No postoperative neurological deficit was noted in any patient.ConclusionsBoth dexmedetomidine and fentanyl can be successfully used in propofol-based TIVA for SSEP monitoring in kyphoscoliosis correction surgeries, but the better analgesic profile, ease of maintaining stable hemodynamics with a significant reduction in inhalational agent requirement, and opioid-sparing effect by dexmedetomidine make it a more desirable agent to be used in propofol-based TIVA.

Roadmap for Motor Evoked Potential (MEP) Monitoring for Patients Undergoing Lumbar and Lumbosacral Spinal Fusion Procedures

ABSTRACT MEPs are recommended for patients undergoing lumbar and lumbosacral procedures in which intraoperative neuromonitoring (IONM) is being utilized. While electromyography (EMG) provides critical nerve root proximity information, spontaneous EMG discharges are relatively poor at reliably diagnosing spinal nerve root dysfunction. In contrast, research indicates that MEPs are both sensitive and specific in diagnosing evolving spinal nerve root dysfunction. There is conflicting evidence, however, and it must be emphasized that the value of adding MEPs is only realized when practices and techniques are optimized. The ideal anesthetic plan is an optimized total intravenous anesthetic (TIVA) regimen. Selection of appropriate anesthetics and dosing is important for optimizing baseline response amplitudes and promoting diagnostic confidence in analyzing signal changes. An adaptive set of alert criteria that account for baseline amplitude and morphology fluctuations should guide the determination of significant signal change. The therapeutic impact of accurate diagnostic information depends on the timeliness of diagnosis and intervention. Prior to the start of surgery, a plan to obtain MEPs at least once every 10 minutes during the active part of the procedure and after every significant surgical maneuver should be agreed upon, and the intervention plan should include but not be limited to possible removal of hardware and release of retraction or distractive forces. In summary, MEPs can improve monitoring of at-risk nerve root function, but the accuracy and therapeutic impact of such monitoring depend on perioperative planning and communication that optimize use of this modality.

Depth of anesthesia by Narcotrend® and postoperative characteristics in children undergoing cardiac surgery under extracorporeal circulation: a retrospective comparison of two anesthetic regimens.

Depth of anesthesia may be insufficient in pediatric cardiac anesthesia if a total intravenous anesthetic regimen with opioids and midazolam is used during cardiopulmonary bypass. The advantages of sevoflurane-based balanced anesthesia may be (1) a more graduated regulation of the depth of anesthesia during cardiopulmonary bypass and (2) a reduction in postoperative ventilation time for children in comparison with total intravenous anesthesia. To evaluate a possibly positive effect of sevoflurane-based balanced anesthesia in children undergoing cardiac surgery we analyzed whether this anesthetic regimen had a significant effect related to (1) depth of anesthesia, (2) the need for opioids during cardiopulmonary bypass as well as on postoperative characteristics such as (3) time of postoperative ventilation, and (4) duration of stay in the intensive care unit in comparison with total intravenous anesthesia. In a retrospective analysis, data from heart-lung machine protocols from 2013 to 2016 were compared according to anesthetic regimen (sevoflurane-balanced anesthesia, n = 70 vs. total intravenous anesthesia, n = 65). Children (age: 8 weeks to 14 years) undergoing cardiac surgery with cardiopulmonary bypass were included. As a primary outcome measure, we compared Narcotrend® system-extracted data to detect insufficient phases of anesthetic depth during extracorporeal circulation under moderate hypothermia. Postoperatively, we measured the postoperative ventilation time and the number of days in the intensive care unit. Furthermore, we analyzed patients' specific characteristics such as opioid consumption during cardiopulmonary bypass. Regression analysis relating primary objectives was done using the following variables: anesthetic regimen, age, severity of illness/surgery, and cumulative dosage of opiates during cardiopulmonary bypass. No significant differences were observed in descriptive patient characteristics (age, body weight, height, and body temperature) between the two groups. Further, no significant differences were found in depth of anesthesia by analyzing phases of superficial B1-C2-electroencephalography Narcotrend® data. No marked difference between the groups was observed for the duration of postoperative intensive care unit stay. However, the postoperative ventilation time (median (95% CI, hours)) was significantly lower in the sevoflurane-based balanced anesthesia group (6.0 (2.0-15.0)) than in the total intravenous anesthesia group (13.5 (7.0-25)). A higher dosage of opioids and midazolam was required in the total intravenous anesthesia group to maintain adequate anesthesia during cardiopulmonary bypass. Regression analysis showed an additional, significant impact of the following factors: severity of illness and severity grade of cardiac surgery (according to Aristotle) on the primary endpoint. In children undergoing cardiac surgery in our department, the use of sevoflurane-balanced anesthesia during cardiopulmonary bypass showed no superiority of inhalational agents over total intravenous anesthesia with opioids and benzodiazepines preventing phases of superficial anesthesia, but a marked advantage for the postoperative ventilation time compared with total intravenous anesthesia.

Anaesthetic and cardiopulmonary evaluation following xylazine-Diazepam-ketamine-propofol administration with or without local infiltration analgesia using mepivacaine during inguinal castration in Donkeys

The present study was performed to investigate the cardiopulmonary responses and hypoalgesic efficacy of diazepam/ketamine anaesthesia induction followed by xylazine-propofol infusion alone (XDKP) or with a local infiltration of mepivacaine (XDKPM) for inguinal castration in donkeys. A 10 male adult donkeys were assigned to two groups (XDKP and XDKPM). Donkeys were sedated by xylazine then anaesthesia was inducted with followed by diazepam/ketamine. Anaesthesia was maintained by propofol infusion 0.1 mg/kg/h. XDKPM group, mepivacaine 2% were locally infiltrated on each side and two min before surgical incision. Both group got smooth induction and recovery. The pain scale scores showed a significant higher compared to baseline in both groups. In conclusion, a combination of XDKP is balanced total intravenous anaesthesia regimen with cardiopulmonary stability in donkeys undergoing inguinal castration. Keywords: xylazine, propofol, mepivacaine, inguinal castration, donkey

Evaluating the Impact of Total Intravenous Anesthesia on the Clinical Outcomes and Perioperative NLR and PLR Profiles of Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

The aim of this study was to assess the impact of total intravenous anesthesia (TIVA) on the perioperative inflammatory profile and clinical outcomes of patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). A retrospective review of patients undergoing CRS-HIPEC was performed. Patients receiving a combination of preoperative tramadol extended release (ER), celecoxib, and pregabalin, along with combined intraoperative infusions of propofol, dexmedetomidine, lidocaine, and ketamine were classified as receiving a TIVA regimen (TIVA group). The second group consisted of patients receiving volatile-opioid-based anesthesia (VO group). The neutrophil:leukocyte (NLR) and platelet: leukocyte (PLR) ratios were calculated to evaluate the perioperative inflammatory status of both groups. Length of stay (LOS) and complications of both groups were also evaluated. A total of 213 patients were included in the study-139 in the VO group and 74 in the TIVA group. No statistically significant differences were observed between the groups with regard to their postoperative inflammatory profiles, LOS, or complications by organ system; however, the incidence of renal complications was higher in the TIVA group (8.1 vs. 2.2%) and approached statistical significance (p=0.068). In this retrospective study of patients undergoing CRS-HIPEC, the combined use of preoperative celecoxib, tramadol ER and pregabalin followed by intraoperative TIVA with infusions of propofol, dexmedetomidine, ketamine, and lidocaine was not associated with a reduction in LOS or complications by organ system. Postoperative NLR and PLR profiles were also not significantly impacted.

Effects of Sevoflurane Inhalation During Cardiopulmonary Bypass on Pediatric Patients: A Randomized Controlled Clinical Trial.

The effects of sevoflurane inhalation during cardiopulmonary bypass (CPB) on postoperative courses and serum cardiac troponin I (cTnI) concentrations in pediatric patients undergoing cardiac surgery have not been extensively investigated. In this single-center, prospective, randomized trial, an anesthetic regimen containing 2% sevoflurane used throughout the CPB process was compared with a total intravenous anesthesia (TIVA) regimen. One hundred and three patients undergoing congenital heart defect repair with CPB were included in this prospective randomized controlled study. They were randomized into two groups: the sevoflurane group, who received 2% sevoflurane during CPB via an oxygenator, and the control group, who received only an oxygen-air mixture. The pre- and intra-operative parameters were comparable between the two groups. There was a slight but significant increase of arterial diastolic pressure in the sevoflurane group immediately after CPB compared with control patients (46.9 ± 9.3 mm Hg vs. 43.6 ± 8.9 mm Hg; p = 0.033). There was no death in either group. The postoperative ventilation time (in mean [95% confidence interval]) was shorter in the sevoflurane group than that in the control group (26.1 [19.2, 33.0] h vs. 37.7 [24.4, 50.9] h; p = 0.014). The postoperative ICU time, hospital days, and serial serum cTnI concentrations were not significantly different between the two groups. Inhalation of 2% sevoflurane during CPB is beneficial to the recovery of pediatric patients undergoing cardiac surgery but has no significant effect on postoperative cTnI release.

Intravenous anaesthesia for thoracic procedures

Total intravenous anesthesia (TIVA) is indicated for procedures in which inhalational anesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. TIVA may also be beneficial in lung volume reduction surgery, lung transplantation, and thymectomy. TIVA is safer and more practical for thoracic procedures performed outside of the operating room, such as off-site locations, military field, or impoverished areas of the world. Target-controlled infusion (TCI) is a relatively new delivery system for TIVA that is based on pharmacokinetic models to optimize intravenous anesthetic delivery. TCI has many advantages over conventional calculator pumps but is not currently available in the United States. Because well-established MAC-type systems for intravenous anesthetics are not available, anesthetic depth monitors are useful in monitoring patients undergoing TIVA. Propofol, dexmedetomidine, ketamine, lidocaine, and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective TIVA regimen. This chapter reviews the balanced TIVA technique currently used at the University of Texas MD Anderson Cancer Center.

Organ Protection by Volatile Anesthetics in Non-Coronary Artery Bypass Grafting Surgery

The cardioprotective properties of volatile anesthetics have been widely demonstrated by numerous randomized studies and meta-analyses in the setting of cardiac surgery, above of all during coronary artery bypass grafting procedures. Recently, conflicting results have been presented in cardiac non-coronary artery bypass grafting surgery. Unfortunately, despite the existence of a great number of studies comparing a total intravenous anesthetic regimen with an inhalational regimen, at present there are no randomized studies presenting data regarding mortality and important outcomes, such as myocardial infarction, in non-cardiac surgery. In this review we analyze and present the results of the most recent and important studies regarding anesthetic preconditioning in cardiac and in noncardiac surgery. Furthermore, we focus on the emerging data from animal experiments, discussing in particular the molecular mechanisms underlying anesthetic preconditioning.

A comparison of volatile and non volatile agents for cardioprotection during on‐pump coronary surgery

A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.

Ketamine-Based Total Intravenous Anesthesia Versus Isoflurane Anesthesia in a Swine Model of Hemorrhagic Shock

Inhalational anesthetics can cause profound hemodynamic effects including decreases in systemic vascular resistance and cardiac inotropy. Although widely used in uncontrolled hemorrhagic shock (UHS), their consequences compared with other anesthetic regimens are not well-studied. Ketamine-based total intravenous anesthesia (TIVA) may produce less profound cardiovascular depression, and has been used during elective surgery but rarely during traumatic shock. The purpose of this study was to compare the effects of isoflurane (ISO) and TIVA regimens in a swine grade V liver injury model. We hypothesized that TIVA would result in less hypotension and dysfunctional inflammation than ISO. Twenty swine were randomized blindly to receive either 1% to 3% ISO, or intravenous ketamine, midazolam, and buprenorphine for maintenance anesthesia. Six animals acted as controls. After sedation and intubation, randomized anesthesia was initiated and monitored by an independent animal technician. Invasive lines were placed followed by celiotomy and splenectomy. Baseline mean arterial pressure (MAP) was documented and a grade V liver injury created. After 30 minutes of UHS, animals were resuscitated with 8 mL of Ringer's lactate per milliliter blood loss at 165 mL/min. MAP and tissue oxygen saturation (StO2) were continuously recorded. The animals were sacrificed 120 minutes after injury and lung tissue was harvested. Serum cytokines (interleukin-6 [IL-6], IL-8, and tumor necrosis factor-alpha [TNF-alpha]) were quantified with enzyme-linked immunosorbent assay. Lung cytokine mRNA levels were quantified with real time reverse transcriptase polymerase chain reaction. Animal weight, liver injury pattern, and blood loss were similar (p > 0.1). The ISO group had a lower MAP at baseline (p = 0.02), at injury (p = 0.004), and study completion (p = 0.001). After resuscitation, MAP decreased in the ISO group but remained stable in the TIVA group. StO2 was significantly higher in the TIVA group immediately after injury (p = 0.004), but similar between groups throughout the remainder of the study. Animals who received TIVA trended toward higher levels of lactate and lower pH throughout the study, reaching significance at 30 minutes postinjury (p = 0.037 and 0.043). Inflammatory cytokine (IL-6, IL-8, and TNF-alpha) production did not differ between groups, however TNF-alpha mRNA production was significantly lower in the TIVA group (p = 0.04). Although a TIVA regimen produced less pronounced hypotension in a swine model of UHS than did ISO, end-organ perfusion with TIVA appeared to be equivalent or inferior to ISO. In circumstances of limited resources, such as those experienced by forward Army surgical teams, a ketamine-based TIVA regimen may be an option for use in UHS.

QS397. Comparison of Inhaled and Intravenous Anesthetic Regimens on Hemodynamics and Inflammation in a Porcine Model of Goal-Directed Resuscitation of Hemorrhagic Shock

Introduction: Previous studies have suggested that a ketamine-based total intravenous anesthetic (TIVA) regimen is superior to an inhaled anesthetic by producing fewer adverse effects. While the use of TIVA has been documented in elective operations, there is limited data on its performance during traumatic shock. The purpose of this study was to evaluate the differential effects of an inhalational anesthetic with a TIVA regimen in the setting of uncontrolled hemorrhagic shock secondary to an induced Grade V liver injury.

Successful Intraoperative Spinal Cord Monitoring During Scoliosis Surgery Using a Total Intravenous Anesthetic Regimen Including Dexmedetomidine

Intraoperative neurophysiological monitoring (IONM) during corrective spinal surgery is widely used. Because of the possible interference with the recording of evoked potentials by inhalational anesthetics, total intravenous anesthetic (TIVA) regimens have been advocated. TIVA regimens may be difficult to use in pediatric populations due to metabolic factors. We report on the results of multimodality IONM during 18 cases in which a TIVA regimen incorporating dexmedetomidine (Precedex, Hespira, Lake Forest, IL) was used. Monitoring techniques included sensory (SSEP) and motor evoked potentials (MEP), as well as pedicle screw stimulation. SSEPs were maintained within an acceptable range of baseline amplitude (50%) and latency (10%), and MEPs remained elicitable throughout each case. We therefore found that the anesthetic regimen did not significantly interfere with any of the monitoring modalities used and conclude that IONM in the presence of dexmedetomidine is feasible under appropriate conditions.

Intravenous anesthesia for thoracic procedures

The article reviews the rationale for using intravenous anesthesia for thoracic operations, the drugs and equipment required, and the methodology involved. Recent studies examining whether total intravenous anesthesia offers a physiological advantage over inhalational anesthesia for thoracic surgery remain inconclusive. Nevertheless, total intravenous anesthesia is preferable for certain thoracic procedures incompatible with effective delivery of inhalational anesthetics. Additionally, total intravenous anesthesia offers advantages in procedures conducted in nonideal environments, such as offsite or austere scenarios. Total intravenous anesthesia is indicated for procedures in which inhalational anesthetics may not be safely or effectively delivered, including endobronchial procedures using flexible or rigid bronchoscopy and proximal airway-disrupting surgeries. Total intravenous anesthesia may be beneficial in lung volume reduction surgery, lung transplantation and thymectomy. Total intravenous anesthesia is safer and more practical for thoracic procedures performed outside of the operating room, such as offsite locations, military field or impoverished areas of the world. Propofol, dexmedetomidine, ketamine and remifentanil may be used in combination with anesthetic depth monitoring to execute an effective total intravenous anesthesia regimen. Target-controlled infusion may improve the delivery of total intravenous anesthesia and is a focus for future research. This article reviews the balanced total intravenous anesthesia technique currently used at the University of Texas M.D. Anderson Cancer Center.

Desflurane and Sevoflurane in Cardiac Surgery: A Meta-Analysis of Randomized Clinical Trials

The authors performed a meta-analysis to investigate whether the cardioprotective effects of volatile anesthetics translate into decreased morbidity and mortality in patients undergoing cardiac surgery. It is commonly believed that the choice of the primary anesthetic agent does not result in different outcomes after cardiac surgery. Recent evidence, however, has indicated that volatile anesthetics improve postischemic recovery at a cellular level, in isolated hearts, in animals, and in humans. Four investigators independently searched BioMedCentral and PubMed. Inclusion criteria were random allocation to treatment and comparison of a total intravenous anesthesia regimen versus an anesthesia plan including desflurane or sevoflurane performed on cardiosurgical patients. Exclusion criteria were duplicate publications, nonhuman experimental studies, and no outcome data. The endpoints were the rate of perioperative myocardial infarction and hospital mortality. The search yielded 22 studies, involving 1,922 patients. Volatile anesthetics were associated with significant reductions of myocardial infarctions (24/979 [2.4%] in the volatile anesthetics group v 45/874 [5.1%] in the control arm, odds ratio [OR] = 0.51 [0.32-0.84], p for effect = 0.008, and p for heterogeneity = 0.77) and mortality (4/977 [0.4%] v 14/872 [1.6%], OR = 0.31 [0.12-0.80], p for effect = 0.02, and p for heterogeneity = 0.88). Desflurane and sevoflurane have cardioprotective effects that result in decreased morbidity and mortality. The present data show for the first time that the choice of an anesthetic regimen based on administration of halogenated anesthetics is associated with a better outcome after cardiac surgery.

THE INFLUENCE OF ANESTHESIA ON A SWINE MODEL OF HEMORRHAGIC SHOCK

Introduction: Inhalational anesthetics can cause profound hemodynamic effects in uncontrolled hemorrhagic shock (UHS). The purpose of this study was to compare the effects of isoflurane anesthesia (ISO) and a ketamine-based total intravenous anesthesia (TIVA) regimen in a swine grade V liver injury model. We hypothesized that TIVA would result in less hypotension than ISO. Methods: Twenty Yorkshire crossbred swine were randomized blindly to receive either 1-3% ISO, or IV ketamine, midazolam, and buprenorphine for maintenance anesthesia. Animals were sedated with Telazol and intubated. Randomized anesthesia was initiated and monitored by an independent animal technician. Invasive lines were placed followed by celiotomy and splenectomy. Baseline mean arterial pressure (MAP) was documented and a grade V liver injury was created. After 30 minutes of UHS, animals were resuscitated with 8ml Ringer's lactate per ml blood loss at 165 ml/min. MAP and tissue oxygen saturation (StO2) were continuously recorded. The animals were sacrificed 120 minutes after injury. Results: Animal weight, number of central veins injured, and blood loss (TIVA-796ml vs. ISO-791ml) were similar (p>0.1). As shown in the figure, the ISO group had a lower baseline MAP (76 vs. 89.5, p = 0.02), and a lower MAP at injury (66.6 vs. 86.4, p < 0.01) and study completion (56.7 vs. 74.9, p < 0.01). Following resuscitation, MAP decreased in the ISO group but stayed the same in the TIVA group. StO2, pH, and lactate were similar between groups following injury. Conclusion: In a swine model of UHS, TIVA produces a higher baseline MAP, and results in maintenance of MAP following resuscitation without compromising tissue perfusion.Figure

THIS ARTICLE HAS BEEN RETRACTED: Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long‐term surgery

Background: The purpose of the study was to compare time of recovery, return of cognitive function, post‐anaesthetic care unit (PACU) stay and costs of a propofol/remifentanil (TIVA) with a desflurane/fentanyl‐based anaesthesia (desflurane group) in surgical procedures lasting more than 150 min.Methods: Forty‐nine patients undergoing elective abdominal prostatectomy were allocated randomly to receive bispectal index (BIS)‐controlled desflurane/fentanyl (n = 24) or propofol/remifentanil (n = 25). Awakening, clinical recovery, direct drug acquisition and post‐operative pain treatment were documented. Cognitive skills were tested using the Mini‐Mental Status (MMST) test.Results: Extubation was significantly faster with desflurane (6.9 ± 3.5 min) than with TIVA (11.2 ± 4.0 min) as well as times for stating name and date of birth (desflurane: 6.1 ± 3.9 and 6.6 ± 4.0 min; TIVA: 12.4 ± 11.5 min and 13.4 ± 11.3 min). There were no significant differences in PACU discharge times or MMS scores between the groups. Significantly more patients suffered post‐operative nausea and vomiting (PONV) in the desflurane (33% vs. 0%) than the TIVA group. Overall costs were significantly higher in the TIVA (58.8 ± 11.6 €) than in the desflurane group (35.0 ± 5.7 €).Conclusion: Patients undergoing prolonged surgical procedures showed a faster early recovery after desflurane/fentanyl than using TIVA, whereas stay in the PACU and recovery of cognitive function were similar in both groups. Costs of a TIVA regimen were significantly higher than using a desflurane‐based anaesthesia technique.

Insignificant effect of desflurane-fentanyl-thiopental on hepatocellular integrity - a comparison with total intravenous anaesthesia using propofol-remifentanil: Retracted

Inhalational anaesthetics have been associated with hepatotoxicity. Even desflurane, with its low solubility in blood and tissues, and its minimal hepatic biotransformation, is known to affect hepatic integrity. The effects of propofol on hepatic function are, however, a matter of controversy. Alpha-glutathione S-transferase (alpha-GST), a sensitive and specific biomarker for hepatic integrity, was measured to assess the influence of total intravenous anaesthesia (TIVA) with propofol vs. anaesthesia with desflurane. Forty-two patients scheduled for elective prostatectomy were randomly allocated to receive either desflurane, fentanyl and thiopental (desflurane group) or propofol and remifentanil (TIVA group). Depth of anaesthesia was guided by bispectral index. Plasma concentrations of alpha-GST and aminotransferases were measured before induction of anaesthesia (TO), at the end of surgery (T1), as well as 2 h (T2) and 24 h (T3) postoperatively. Haemodynamic parameters and bispectral index values were documented. alpha-GST increased significantly in the desflurane group from TO (3.0 +/- 2.2 microg L(-1)) to T1 and T2 (5.5 +/- 4.3 and 5.6 +/- 3.7 microg L(-1), respectively), whereas no changes were seen in the TIVA group. alpha-GST values above the normal upper limit (> 7.5 microg L(-1)) were seen in 24% of the patients receiving desflurane. Aminotransferases remained unchanged in both groups throughout the study period. The use of propofol as part of a TIVA regimen seems to have no influence on hepatocellular function during and after surgery. In contrast, patients receiving desflurane showed a transient slight, but significant, increase of alpha-GST to above the normal upper limit after anaesthesia, although this was without further clinical relevance.

This Month in Anesthesiology

This Month in Anesthesiology