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Evidence-based Practice and Quality Improvement

Desflurane in comparison to Sevoflurane in cirrhotic patients undergoing major liver resection

1AP3-3

Yassen, K.1; Hussien, Abou M.2; Mahmoud, F.1; Beltagy, R.3; Hasanin, A.1; Attar, A.3

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European Journal of Anaesthesiology (EJA): June 2014 - Volume 31 - Issue - p 11
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Background and Goal of Study: General Anaesthesia for cirrhotic patients undergoing liver resection faces the challenge of possible haemodynamic changes, hepatic and renal dysfunction after resection. Desflurane (D) is compared to Sevoflurane (S) based anesthesia in cirrhotic patients

Materials and methods: A prospective hospital based comparative study. 50 cirrhotic patients (Child A) with simple random method (D group n=25 and S group n=25). Maintenance with Et Des or Sevoflurane changes by 1% from MAC to keep Entropy between 40-60. Liver and kidney functions tests, Urinary Microalbuminurea (Microalb), blood Glutathione-S-transferase (GST), were assayed. Haemodynamics monitored with invasive blood pressure and Transoesophageal Doppler monitors. Extubation time, Inhalational agent consumption and cost, intensive care and hospital stay were recorded. Data presented as mean ± SD.

Results and discussion: Mean systemic vascular resistance (SVR) was better preserved with D vs S (835.04± 12.02 vs 778.16±11.97dyn.sec.cm-5, P< 0.01) respectively, this was also associated with a higher mean Stroke volume (85.72±2.95 vs76.16±6.52 ml, P< 0.01) respectively. CVP and corrected flow time FTc of Doppler kept within normal ranges. No difference between D and S post resection as regards hepatic and renal functions, blood Glutathione-S-Tranferase (GST) (316.96±16.58 vs 312.48± 16.48 IU/ml, P>0.05) and urine Microalbuminurea (7.28±3.35 vs 7.28±3.35 microgram/ml, P>0.05). Extubation time was significantly shorter in D group (4.52±2 versus 7.72±2 min). Desflurane consumption compared to Sevoflurane was 73±17 vs 64±22 ml, P< 0.05, D cost was significantly more economic. No difference in intensive care and hospital stay (P>0.05).

Conclusion(s): Desflurane can be considered a more appropriate choice than Sevoflurane in cirrhotic patients undergoing major liver resections from haemodynamics prospective, recovery and costs, but neither is superior to the other in respect to liver and kidney functions.

© 2014 European Society of Anaesthesiology