Structural and ultrastructural studies on normal and bilharzial human liver following isoflurane and sevoflurane anaesthesia

Liver specimens from 30 adult female patients with normal liver function tests were examined. Half of the patients were normal and the other half had history of bilharziasis. All patients had chronic calcular cholecystitis and scheduled to undergo open cholecystectomy. After induction of anesthesia with fentanyl, propofol and vecuronium, anesthesia was maintained with 65% nitrous oxide in oxygen supplemented by propofol infusion as total intravenous anesthesia to the control group or by one minimum alveolar concentration [MAC] to patients of either isoflurane or sevoflurane groups. Approximately, 60 minutes after starting the maintenance anesthetic agents, a liver biopsy was taken from each patient and processed for light and electron microscopy. Similar structural and ultrastructural changes were detected in both normal and bilharzial liver specimens after the use of isoflurane and sevoflurane anesthetics. Those changes only differed in magnitude. They were in the form of focal sinusoidal dilatation, cellular swelling, nuclear and mitochondria1 degeneration, fragmentation of rough endoplasmic reticulum [rER], increased lysosomes, cytoplasmic vacuolation which may be partially or completely surrounded by membrane and may contain electron dense granular structures

Intubating conditions and neuromuscular blocking effects of rocuronium during sevoflurane, isoflurane and total intravenous anaesthesia

The present study was performed to assess the tracheal intubating conditions, onset, duration of and recovery from rocuronium 0.6 mg/kg during 1 MAC of either sevoflurane anesthesia with 70% nitrous oxide in oxygen [10 min. steady state] or during propofol infusion as total intravenous anesthesia [TIVA] with 70% nitrous oxide in oxygen. Forty-five [ASA I and II] patients, aged 23-48 years, undergoing elective surgery were divided into three equal groups [sevoflurane, isoflurane and TIVA groups]. Anesthesia was induced with fentanyl 1-2 mug/kg and propofol 2-25 mg/kg i.v. Tracheal intubation started 60 seconds following rocuronium administration. Intubating conditions were assessed using a standardized scoring system. Neuromuscular blockade was evaluated by recording the force of contraction of the adductor muscle in response to train-of-four [TOF] stimulation at 2 Hz every 15 seconds. The first twitch [T1] of the TOF stimulus was used as the study parameter. It was revealed that the duration of and recovery from rocuronium were significantly prolonged during sevoflurane anesthesia in comparison with isoflurane and TIVA technique. A particular attention should be paid to the monitoring of neuromuscular block during sevoflurane anesthesia