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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
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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

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