Effects of propofol versus isoflurane on liver function after open thoracotomy

Abstract

Background

Anesthetic agents and type of surgery may contribute to postoperative hepatic injury. Inhalational anesthetics have been associated with hepatic dysfunction after surgery, however, propofol is expected to have a lower potential for postoperative liver injury. This prospective double-blind randomized clinical study was planned to determine whether postoperative liver function differs after anesthesia with isoflurane and total intravenous anesthesia with propofol in patients undergoing a posterolateral thoracotomy.

Methods

Eighty-eight patients in American Society of Anesthesiologists physical status 1 or 2, aged 16–60 years, and scheduled for an elective posterolateral thoracotomy, were randomly assigned to an anesthetic protocol: propofol (n = 44) or isoflurane (n = 44). Induction of anesthesia was similar in both groups. Serum levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, total bilirubin, and γ-glutamyltransferase were measured before induction of anesthesia and on the first and third days after either propofol or isoflurane anesthesia.

Results

Mild changes in postoperative serum levels of liver enzymes were significant within each group but the differences between groups were not significant.

Conclusions

Propofol and isoflurane anesthesia have a comparable minor effect on liver function after an elective posterolateral thoracotomy.

Keywords

Anesthetics inhalation isoflurane liver function tests postoperative complications propofol thoracotomy

Get full access to this article

View all access options for this article.

References

Clarke

Doggart

Lavery

. Changes in liver function after different types of surgery. Br J Anaesth 1976; 48: 119–128.

Reichle

Conzen

. Halogenated inhalational anaesthetics (Review). Best Pract Res Clin Anaesthesiol 2003; 17: 29–46.

Daves

. The liver and vascular surgery. Semin Cardiothorac Vasc Anesth 2000; 4: 275–88. Available at: http://scv.sagepub.com/content/4/4/275.refs. Accessed August 28, 2014.

O’Connor

Rothenberg

Tuman

Anesthesia and the hepatobiliary system. In: Miller

(ed.). Miller’s Anesthesia, 7th ed. Philadelphia: Elsevier Churchill Livingstone, 2010, pp. 2135–49.

Trca

Krska

Kittnar

. Hemodynamic response to thoracoscopy and thoracotomy. Physiol Res 2010; 59: 363–371.

Targa

Droghetti

Caggese

Zatelli

Roccella

. Rhabdomyolysis and operating position. Anaesthesia 1991; 46: 141–143.

Pratt

Kaplan

. Evaluation of abnormal liver-enzyme results in asymptomatic patients. New Engl J Med 2000; 342: 1266–1271.

Ziser

Friedhoff

Rose

. Prone position: visceral hypoperfusion and rhabdomyolysis. Anesth Analg 1996; 82: 412–415.

Ono

Tanita

Suzuki

Fujimura

. Thoracic surgery and liver dysfunction. Nihon Geka Gakkai Zasshi 1997; 98: 667–670.

10.

O’Riordan

O’Beirne

Young

Bellamy

. Effects of desflurane and isoflurane on splanchnic microcirculation during major surgery. Br J Anaesth 1997; 78: 95–96.

11.

Kim

Ryu

. Comparison of hepatic and renal function between inhalation anesthesia with sevoflurane and remifentanil and total intravenous anesthesia with propofol and remifentanil for thyroidectomy. Korean J Anesthesiol 2013; 64: 112–116.

12.

Kneiseler

Bachmann

Bechmann

. A rare case of propofol-induced acute liver failure and literature review. Case Rep Gastroenterol 2010; 4: 57–65.

13.

Kim

Shin

Kim

. The effect of enflurane, isoflurane and propofol on hepatic function in tympanomastoidectomy. Korean J Anesthesiol 2003; 45: 30–6. Available at: http://koreamed.org/SearchBasic.php?RID=1011KJAE%2F2003.45.1.30&DT=1&QY=%22Korean+J+Anesthesiol%22+%5BJTI%5D++AND+45+%5BVO%5D+AND+1+%5BISSU%5D. Accessed August 28, 2014.

14.

Murray

Phillips

Fee

. Comparison of the effects of isoflurane and propofol on hepatic glutathione-S-transferase concentrations during and after prolonged anaesthesia. Br J Anaesth 1994; 72: 599–601.

15.

Yoon

Cho

Kim

. Comparisons of propofol, enflurane, sevoflurane, and desflurane anesthesia in laparoscopic cholecystectomy on postoperative liver enzyme levels. Korean J Anesthesiol 2005; 49: 18–24. Available at: http://ekja.org/search.php?where=aview&id=10.4097/kjae.2005.49.1.18&code=1011KJAE&vmode=FULL. Accessed August 28, 2014.

16.

Nishiyama

Yokoyama

Hanaoka

. Liver function after sevoflurane or isoflurane anaesthesia in neurosurgical patients. Can J Anaesth 1998; 45: 753–756.

17.

Tiainen

Lindgren

Rosenberg

. Changes in hepatocellular integrity during and after desflurane or isoflurane anaesthesia in patients undergoing breast surgery. Br J Anaesth 1998; 80: 87–89.

18.

Kim

Woo

. Comparison of propofol with enflurane anesthesia in laparoscopic cholecystectomy for the change of liver function. Korean J Anesthesiol 1999; 36: 279–85. Available at: http://koreamed.org/SearchBasic.php?RID=1011KJAE%2F1999.36.2.279&DT=1&QY=%22Korean+J+Anesthesiol%22+%5BJTI%5D++AND+36+%5BVO%5D+AND+2+%5BISSU%5D. Accessed August 28, 2014.

19.

Lorsomradee

Cromheecke

Lorsomradee

De Hert

. Effects of sevoflurane on biomechanical markers of hepatic and renal dysfunction after coronary artery surgery. J Cardiothorac Vasc Anesth 2006; 20: 684–690.

20.

Ihtiyar

Algin

Haciolu

Isiksoy

. Fatal isoflurane hepatotoxicity without re-exposure. Indian J Gastroenterol 2006; 25: 41–42.