Anesthesia for laparoscopic cholecystectomy in cirrhotic patients: a comparison of sevoflurane versus isoflurane

ABSTRACT

This study aimed to compare the effect of anesthesia using isoflurane [ISO] or sevoflurane [SEVO] in conjunction with nitrous oxide on postoperative liver function tests in 30 cirrhotic patients [Child-Pugh Grade A] assigned to undergo laparoscopic cholecystectomy [LC]. Anesthesia was maintained with either sevoflurane [SEVO group] or isoflurane [ISO group] with nitrous oxide 3 L/min in oxygen 3 L/min. Non-invasive intraoperative monitoring included heart rate [HR], systolic and diastolic blood pressure [SBP and DBF] estimated before induction of anesthesia [T[1]], 5 min. after insufflation [T[2]], 5-min after tilting in reverse Trendlenburg position [T[3]] and after exsufflation of CO2 [T[4]]. Venous blood samples were taken for estimation of serum levels of aspartate [AST] and alanine [ALT] aminotransferases, total bilirubin [TB] and alkaline phosphatase [AP] before and I, 3, and 7 days after surgery. Another venous blood samples were taken at time of induction of anesthesia, at, 2-hrs and 24-hrs after the end of surgery for estimation of serum levels of a-glutathione S-transferase [GST]. The formation of the lidocaine metabolite monoethylglycinexylidide [MEGX Test] was estimated preoperatively and immediately postoperative. All patients developed significantly higher HR, SBP and DBF at T[2] and T[3] compared to at T[1] with a significantly higher measures at T[3] compared to at T[2], but measures recorded at T[4] were significantly lower compared to that recorded at T[2] and T[3] in both groups with a significantly lower blood pressure in ISO group and non-significantly lower blood pressure measures in SEVO group compared to measures recorded at T[1]. Postoperative serum AST and ALT levels were significantly higher compared to preoperative levels in both groups reaching a peak at 3-days PO and declined on the 7[th] PO day with significantly higher levels in ISO group compared to SEVO group at 3-day and 7-day PO. Serum GST levels estimated at and 2-hrs after end of surgery were significantly higher in both groups compared to levels estimated at time of induction of anesthesia with significantly higher levels at 2-hrs compared to levels estimated at end of surgery in both groups, but was significantly higher in ISO group compared to SEVO group. Postoperative serum MEGX levels were significantly lower in both groups compared to levels estimated at time of induction of anesthesia with a nonsignificant difference between both ISO and SEVO group. It could be concluded that LC in cirrhotic patients performed under sevoflurane anesthesia supplemented by NO[2] is a feasible safe procedure with less postoperative impairment of liver function tests in comparison to isoflurane anesthesia and serum GST and MEGX are useful early biomarkerfor liver dysfunction that precede enzymes alteration in cirrhotic patients undergoing LC