DESFLURANE COMPARED TO SEVOFLURANE FOR CIRRHOTIC PATIENTS UNDERGOING MAJOR LIVER RESECTION. A RANDOMIZED CONTROL STUDY.

Abstract

Background: Major liver resection is associated with haemodynamic, hepatic and renal changes as a result of the procedure.

Aim: To compare Desflurane (D) versus Sevoflurane (S) on hepatic, renal functions, haemodynamics and perioperative course for cirrhotic patients undergoing major liver resection.

Patients and methods: A prospective randomized control study with 50 patients (Child A) (D, n = 25 and S, n = 25). End tidal D or S adjusted with Entropy (40-60). Haemodynamics monitored with invasive blood pressure and trans-oesophageal Doppler (TED). Liver and kidney function tests, blood Glutathione-S-transferase (GST), urinary microalbuminuria (Microalb) were assayed. Extubation time and anaesthetic consumption were recorded.

Results: Systemic vascular resistance (SVR) post-resection and stroke volume of D vs S were 835.04 ± 12.02 vs 778.16 ± 11.97 dyn.sec.cm(-5), P < 0.01, and 85.72 ± 2.95 vs 76.16 ± 6.52 ml, P < 0.01 respectively. Doppler corrected flow time (FTc) between groups were comparable (P > 0.05). No difference post-operatively regarding hepatic and renal functions, and urine Microalb (14.76 ± 3.95 vs l4.24 ± 8.65 µg/ml, P = 0.78), but a statistically difference was found with GST (0.046 ± [symbols: see text], vs 0.043 ± [symbols: see text] IU/ml, P < 0.01). Despite a higher D consumption (73 ± 17 vs 64 ± 22 ml, P = 0.102), cost in Egyptian pounds (LE) was lower with D (141.14 ± 32.90 vs 320.60 ± 114.01, LE, P < 0.01). Extubation time and ICU stay with D vS (4.52 ± 2 vs 7.72 ± 2 min, P < 0.01) and (1.40 0.50 vs 1.64 ± 0.48, days P = 0.09) respectively.

Conclusion: Neither D nor S were clinically superior to the other with respect to liver and kidneys functions, but D was found to preserve better the haemodynamic parameters and enhance recovery at a lower cost.