Influence of the choice of volatile anesthetics on liver enzymes after surgical liver resections
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Дата
2012-04
Автори
Petrov, Kr.
Kobakov, G.
Manova, M.
Mitov, К.
Savova, A.
Petrova, G.
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Издател
Централна медицинска библиотека, МУ София / Central Medical Library - MU Sofia
Резюме
The purpose of this study was to evaluate the possible superiority
in pharmacological protective effect of sevofl urane compared to isofl urane in patients
with liver segmental or lobe resections, through examination of postoperative
changes in the liver enzymes ALT and AST and the impact of the choice of anesthetic
on surgical hospital charges. It is a prospective study based on the examination
of surgical patients. A retrospective cost study analysis after approval of local
ethics committee was also performed. Patients with surgical liver resections were
divided in two groups according to the main volatile anesthetic used − isofl urane
(n = 25) and sevofl urane (n = 17) group. All patients were tested for both liver enzymes
AST and ALT before and after the surgery. The health care resources used
during the anesthesia were collected. Mean time of operation, minimal alveolar
concentration (MAC), average anesthetic quantity used, fresh gas fl ow, and cost for
maintaining anesthesia were calculated. The cost for maintaining anesthesia was
compared with the surgical hospital charges. No statistically signifi cant difference
has been observed between the two groups according to patients’ age, type of liver
resection, as well as hospital stay (р > 0.05). Comparing the postoperative levels
of AST and ALT, we found that their levels were higher in the group of patients on
isofl urane. Levels of both ALT and AST were signifi cantly lower, and decreased
more rapidly in patients receiving sevofl urane than those receiving isofl urane from
1st to 5th postoperative day. The decrease was almost twice faster in the group on
sevofl urane and close to normal physiological levels. All hospital costs appear to be
equal in both groups except the cost of maintaining anesthesia that represents 1.67
per cent of hospital charges in the group on sevofl urane and 0.41 per cent in the
group on isofl urane. In conclusion, for patients that are going to have liver resection,
the preferred main anesthetic in the complex of balanced anesthesia should
be sevofl urane, which decreases the AST and ALT levels signifi cantly. For both anesthetics the total cost for maintaining anesthesia is an insignifi cant part of the
surgical hospital charges and the choice of anesthetic should be based on clinical
results rather than on economical ones.
Описание
Address for correspondence:
Guenka I. Petrova;
Faculty of Pharmacy;
Medical University of Sofia;
2 Dunav str.;
Sofia 1000, Bulgaria;
tel. + 35 92 9236 545 ;
tel. + 35 92 987 9874 ;
e-mail: guenka.petrova@gmail.com
Ключови думи
anesthesia, sevoflurane, isoflurane, anesthesia cost, liver resections, ALT, AST
Цитирания
Kr. Petrov, G. Kobakov, M. Manova, К. Mitov, A. Savova and G. Petrova. Infl uence of the choice of volatile anesthetics on liver enzymes after surgical liver resections - Acta medica bulgarica , 39, 2012, No 1, 3-8.