Propofol/dexmedetomidine Versus Desflaurane Effects on Post Hepatectomy Hepatocellular Injury

ABSTRACT

Objective

The Pringle maneuver used during hepatectomy causes ischemic reperfusion injury to the liver remnant. In this study, we compared the effect of maintenance of general anesthesia with propofol dexmedetomidine intravenous infusion versus desflurane inhalational anesthesia on post-hepatectomy hepatocellular injury in patients undergoing partial hepatectomy during the first six postoperative days.

Methods

Group A (15 patients) received total intravenous anesthesia with a combination of propofol and dexmedetomidine for anesthesia maintenance, and group B (15 patients) received desflurane for anesthesia maintenance. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum albumin, serum bilirubin, prothrombin time (PT), and international normalized ratio (INR) were measured before surgery and at 1, 3, and 6 days after surgery.

Results

Transaminase levels, which were comparable in both groups, peaked between the first and the third postoperative days. The peak ALT was 224.27 ± 29.7 and 318.20 ± 52.5 U/L in group A and group B, respectively (P < 0.001). The peak AST was 265.60 ± 22.3 U/L in group A and 349.27 ± 56.1 U/L in group B (P < 0.001). Albumin levels at day 1 showed no significant differences between both groups, but at days 3 and 6, group A showed significantly higher albumin levels than group B. Other liver function tests including serum albumin, total and direct bilirubin, PT, and INR showed lower values in the propofol/dexmedetomidine group.

Conclusion

The main finding of this study is that propofol/dexmedetomidine as a technique for the maintenance of anesthesia resulted in less hepatocellular injury and better hepatic functions than desflurane in patients undergoing partial hepatectomy during the first six postoperative days.

Acknowledgments

We agree that all copyright ownership is transferable to the Egyptian journal of Anesthesia when the manuscript is accepted for publication.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

O.A.L. designed the study, revised the literature, performed the analysis, followed up the patients, documented the changes in the desired outcomes, and wrote the manuscript. H.M.E. designed the study, performed the analysis, and wrote and critically revised the manuscript. S.M.T. revised the literature, performed the analysis, and critically reviewed the manuscript. M.M.G. revised the feasibility of the surgical intervention for proper patients, followed up the patients, and critically reviewed the manuscript. M.M.R. collected the data, performed the analysis, and critically reviewed the manuscript. All authors approved the final version of the manuscript.

Ethics approval and consent to participate

After approval of the ethical committee in Faculty of Medicine, Ain Shams University (number FMASU M D 209/2020), this interventional prospective study was conducted on 30 patients over 2 years from November 2020 to November 2022. Written informed consent was obtained from patients’ legal guardian(s) after explaining the procedure and its potential complications.

Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

No funds, sponsorship, or financial support to be disclosed.