Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-24T06:12:17.837Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  19 April 2005

K. D. Röhm ,
S. W. Suttner ,
J. Boldt ,
T. A. H. Schöllhorn  and
S. N. Piper
K. D. Röhm
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
S. W. Suttner
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
J. Boldt
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
T. A. H. Schöllhorn
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
S. N. Piper
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany
Get access

Abstract

Summary

Background and objective: 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 (α-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.

Methods: 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 α-GST and aminotransferases were measured before induction of anaesthesia (T0), 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.

Results: α-GST increased significantly in the desflurane group from T0 (3.0 ± 2.2 μg L−1) to T1 and T2 (5.5 ± 4.3 and 5.6 ± 3.7 μg L−1, respectively), whereas no changes were seen in the TIVA group. α-GST values above the normal upper limit (>7.5 μg L−1) were seen in 24% of the patients receiving desflurane. Aminotransferases remained unchanged in both groups throughout the study period.

Conclusions: 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 α-GST to above the normal upper limit after anaesthesia, although this was without further clinical relevance.

Keywords

ANAESTHETICS, desflurane, propofolOPIOIDS, remifentanilANAESTHESIA, intravenous, inhalationalGLUTATHIONE TRANSFERASE, alpha, hepaticTRANSAMINASES, alanine aminotransaminase, aspartate aminotransaminase
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 209 - 214
Copyright
2005 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kenna JG, Van Pelt FNAM. The metabolism and toxicity of inhaled anaesthetic agents. Anaesth Pharm Rev 1994; 2: 29–42.Google Scholar
Ray DC, Drummond GB. Halothane hepatitis. Br J Anaesth 1991; 67: 84–99.Google Scholar
Tianinen P, Lindgren L, Rosenberg PH. Changes in hepatocellular integrity during and after desflurane or isoflurane anaesthesia in patients undergoing breast surgery. Br J Anaesth 1998; 80: 87–89.Google Scholar
Eger II EI. New inhaled anesthetics. Anesthesiology 1994; 80: 906–922.Google Scholar
Suttner SW, Schmidt CC, Boldt J, et al. Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients. Anesth Analg 2000; 91: 206–212.Google Scholar
Murray JM, Phillips AS, Fee JPH. Comparison of the effects of isoflurane and propofol on hepatic glutathione S-transferase concentration during and after prolonged anaesthesia. Br J Anaesth 1994; 72: 599–601.Google Scholar
Tiainen P, Lindgren L, Rosenberg PH. Disturbance of hepatocellular integrity associated with propofol anaesthesia in surgical patients. Acta Anaesth Scand 1995; 39: 840–844.Google Scholar
Beckett GJ, Chapman BJ, Dyson EH, Hayes JD. Plasma glutathione S-transferase measurements after paracetamol overdose: evidence for early hepatocellular damage. Gutt 1985; 26: 26–31.Google Scholar
Beckett GJ, Hayes JD. Glutathione S-transferases: biomedical applications. Adv Clin Chem 1993; 30: 281–380.Google Scholar
Beckett GJ, Hayes JD. Plasma glutathione S-transferase measurements and liver disease in man. J Clin Biochem Nutr 1987; 2: 1–24.Google Scholar
Allan LH, Hussey AJ, Howie J, et al. Hepatic glutathione S-transferase release after halothane anaesthesia: open randomised comparison with isoflurane. Lancet 1987; I: 771–774.Google Scholar
Johansen JW, Sebel PS. Development and clinical application of electroencephalographic bispectrum monitoring. Anesthesiology 2000; 93: 1336–1344.Google Scholar
Suttner SW, Boldt J, Schmidt CC, et al. The effects of sodium nitroprusside-induced hypotension on splanchnic perfusion and hepatocellular integrity. Anesth Analg 1999; 89: 1371–1377.Google Scholar
Hussey AJ, Aldridge LM, Paul D, et al. Plasma glutathione S-transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane. Br J Anaesth 1988; 60: 130–135.Google Scholar
Murray JM, Rowlands BJ, Trinick TR. Indocyanine green clearance and hepatic function during and after prolonged anaesthesia: comparison of halothane with isoflurane. Br J Anaesth 1992; 68: 168–171.Google Scholar
Piper SN, Haisch G, Kumle B, et al. Effects of esmolol- and sodium nitroprusside-induced hypotension on hepatocellular integrity in patients undergoing endonasal sinus sugery. Anaesthesiol Intensivmed Notfallmed Schmerzther 2003; 38: 781–786.Google Scholar
Ray DC, Robbins AG, Howie AF, Beckett GJ, Drummond GB. Effect of spinal anaesthesia on plasma concentration of glutathione S-transferase. Br J Anaesth 2002; 88: 285–287.Google Scholar
Armbruster K, Noldge-Schomburg GF, Dressler IM, Fittkau AJ, Haberstroh J, Geiger K. The effects of desflurane on splanchnic hemodynamics and oxygenation in the anesthetized pig. Anesth Analg 1997; 84: 271–277.Google Scholar
Schindler E, Muller M, Zickmann B, Kraus H, Reuner KH, Hempelmann G. Blood supply to the liver in the human after 1 MAC desflurane in comparison with isoflurane and halothane. Anaesthesiol Intensivmed Notfallmed Schmerzther 1996; 31: 344–348.Google Scholar
Bauer C, Sattel C, Grundmann U, Bauer M, Marzi I, Larsen R. Effects of desflurane on liver microcirculation in comparison with isoflurane and pentobarbital. An intravital microscopy study in the rat. Anaesthesiol Intensivmed Notfallmed Schmerzther 1995; 30: 226–230.Google Scholar
Hartman JC, Pagel PS, Proctor LT, Kampine JP, Schmeling WT, Warltier DC. Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs. Can J Anaesth 1992; 39: 877–887.Google Scholar
Fukushima M, Matsumoto N. Effects of propofol infusion on respiration, systemic circulation and regional organ blood flow. Masui 1999; 48: 1105–1112.Google Scholar
Kenna JG, Jones RM. The organ toxicity of inhaled anesthetics. Anesth Analg 1995; 81: S51–S66.Google Scholar
Schmidt CC, Suttner SW, Piper SN, Nagel D, Boldt J. Comparison of the effects of desflurane and isoflurane anaesthesia on hepatocellular function assessed by alpha glutathione S-transferase. Anaesthesia 1999; 54: 1207–1211.Google Scholar
Ray DC, Bomont R, Mizushima A, et al. Effect of sevoflurane anaesthesia on plasma concentrations of glutathione S-transferase. Br J Anaesth 1996; 77: 404–407.Google Scholar
Koblin DD. Characteristics and implications of desflurane metabolism and toxicity. Anesth Analg 1992; 75: S10–S16.Google Scholar
Murray JM, Trinick TR. Hepatic function and indocyanine green clearance during and after prolonged anaesthesia with propofol. Br J Anaesth 1992; 69: 643–644.Google Scholar
Taivainen T, Tiainen P, Meretoja OA, Räiha L, Rosenberg PH. Comparison of sevoflurane and halothane on the quality of anaesthesia, serum glutathione transferase alpha and fluoride in paediatric patients. Br J Anaesth 1994; 73: 590–595.Google Scholar
Chen TL, Wu CH, Chen TG, Tai YT, Chang HC, Lin CJ. Effects of propofol on functional activities of hepatic and extrahepatic conjugation enzyme systems. Br J Anaesth 2000; 84: 771–776.Google Scholar
Bao Y, Williamson G, Tew D, Plumb GW, et al. Antioxidant effects of propofol in human hepatic microsomes: concentration effects and clinical relevance. Br J Anaesth 1998; 81: 584–589.Google Scholar
Shimono H, Goromaru T, Kadota Y, Tsurumaru T, Kanmura Y. Propofol displays no protective effect against hypoxia/reoxygenation injury in rat liver slices. Anesth Analg 2003; 97: 442–448.Google Scholar
Howie AF, Spencer E, Beckett GJ. Aspartate transferase, alanine aminotransferase, and glutathione transferase in plasma during and after sedation by low-dose isoflurane or midazolam. Clin Chem 1992; 38: 476–479.Google Scholar
Aldridge LM, Ray DC, Noble DW, Howie AF, Beckett GJ, Drummond GB. Glutathione S-transferase measurement can detect impaired hepatocellular integrity in anaesthetised, ventilated subjects. Clin Chem Enzym Commun 1993; 5: 195–203.Google Scholar