Volatile anesthetics might be more beneficial than propofol for postoperative liver function in cirrhotic patients receiving hepatectomy

Summary Hepatic inflow occlusion during the liver surgery may result in a transient ischemia period followed by reperfusion, and may initiate liver injury and lead to postoperative liver dysfunction. Especially in cirrhotic patients, the tolerance time of ischemia is much shorter and the outcome wou...

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Bibliographic Details
Published in:Medical hypotheses 2010-12, Vol.75 (6), p.555-557
Main Authors: Tao, K.M, Yang, L.Q, Liu, Y.T, Tao, Y, Song, J.C, Wu, F.X, Yu, W.F
Format: Article
Language:English
Subjects:
Anesthetics, Inhalation - pharmacology
Anesthetics, Inhalation - therapeutic use
Heme Oxygenase (Decyclizing) - metabolism
Hepatectomy - adverse effects
Humans
Hypoxia-Inducible Factor 1 - metabolism
Internal Medicine
Isoflurane - analogs & derivatives
Isoflurane - pharmacology
Isoflurane - therapeutic use
Liver - drug effects
Liver - metabolism
Liver Cirrhosis - surgery
Methyl Ethers - pharmacology
Methyl Ethers - therapeutic use
Nitric Oxide Synthase Type II - metabolism
Propofol
Reperfusion Injury - etiology
Reperfusion Injury - prevention & control
Volatilization
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Summary:Summary Hepatic inflow occlusion during the liver surgery may result in a transient ischemia period followed by reperfusion, and may initiate liver injury and lead to postoperative liver dysfunction. Especially in cirrhotic patients, the tolerance time of ischemia is much shorter and the outcome would be worse. Recently, clinical trials had proved that volatile anesthetics rather than propofol can protect myocardial cells from ischemia reperfusion (IR) injury in cardiac surgery. Meanwhile, animal studies had revealed that volatile anesthetics could induce some endogenous protective molecules in the liver such as hypoxia induced factor-1 (HIF-1), heme oxygenase (HO) enzyme system and inducible nitric oxide synthase (iNOS), which make the volatile anesthetics posing the extraordinary anti-oxidative, anti-inflammatory, anti-apoptotic, and vasodilatory characteristics. However, there is still lack of trials to compare the postoperative outcomes such as liver function in cirrhotic patients undergoing liver surgery with inflow occlusion between volatile anesthetics and propofol anesthesia. Hence we hypothesize that with its anti-IR injury characteristics, volatile anesthetics might be the more appropriate choice in cirrhotic patients undergoing liver surgery with occlusion.
ISSN:0306-9877
1532-2777
DOI:10.1016/j.mehy.2010.07.028