Protection of cirrhotic liver during anesthesia

ABSTRACT

The combination of antioxidant compounds is beneficial to ameliorate hepatotoxicity in cirrhotic patient undergoing general anesthesia as indicated by reduction of the up-regulation of soluble adhesion molecule [sICAM-1] level and other liver functions. Twenty two surgical patients [child class A] divided into two groups. Antioxidant group received one gm.h-1 of N-acetyl cysteine [Mucomyst] infusion after induction of anesthesia and continuously till the end of surgery. One gram of ascorbic acid [Vitamin C] and 400 IU of -tocopherol [Vitamin E] were administered iv over 10-15 min with closure of rectus sheath. The other group received equal volumes of normal saline during the same periods. Three blood samples were taken from every patient before induction of anesthesia, one hour and one day after surgery for measurement of sICAM-1 and other liver functions [total proteins, serum albumin, alanine aminotransferase [ALT], aspartate aminotransferase [AST], alkaline phosphatase [ALP], total and direct serum bilirubin]. sICAM-1 increased in both groups in the postoperative samples with more increase in saline group [P < 0.05]. Other liver functions showed significant increase in ALT, AST and ALP one hour postoperatively in saline group only. After one day they increased in both groups with more significant elevation in saline group. Serum total proteins, serum albumin, total and direct bilirubin showed no significant changes in both groups. These results proved that the combination of antioxidant compounds during general anesthesia in cirrhotic patient reduce the up-regulation of sICAM-1 which appear to be a good marker for hepatic impairments