Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study
- *Corresponding Author:
- Khaled Yassen
Department of Anesthesia
Liver Institute,Menoufiya University, Egypt
Tel: 0020 10 6 30 80170
E-mail: [email protected]
Received date: September 02, 2014; Accepted date: December 03, 2014; Published date: December 15, 2014
Citation: Yassen K, Safty AF, Abdullah MH, Beltagy RS, Mahmoud FA, et al.(2014) Effect of Target-Controlled Infusion of Propofol-Fentanyl versus Desflurane in Cirrhotic Patients Undergoing Major Hepatic Resection with Transoesophageal Doppler Monitoring A Randomized Control Study. J Anesth Clin Res 5:485. doi: 10.4172/2155-6148.1000485
Copyright: © 2014 Yassen K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background and aim: The choice of anaesthetic agents is important for cirrhotics undergoing liver resection. Aim is to compare Target Controlled Infusion (TCI) Propofol-Fentanyl versus Desflurane (Des) on recovery, hemodynamics monitored with Transoesophageal Doppler (TED), the effect on hepatocellular, kidney functions and economics. Patients and methods: Prospective randomized controlled study, 50 patients (Child A) divided equally. In (Des) group induction with fentanyl (1microgram/kg), propofol (2 mg/kg) and rocuronium (1 mg/kg) and maintenance with Desflurane. In (TCI) group the Propofol blood target concentration (Ct) for induction was set at 4 μg/min and Fentanyl infusion was set at 3 μg/kg for 30 seconds , 2 μg/kg/h for 30 min, 1.5 μg/kg/h from 31-150 min, and 1 μg/kg/h until 30 min before end. Both propofol and fentanyl maintained with Navigator pharmacokinetic software and Entropy guidance. TED, urinary micro albuminurea (microalb), blood Glutathione-S-transferase (GST) were monitored. Results: Extubation time prolonged with TCI vs. Des (15.2 ± 2.6 vs. 9.7 ± 1.5 min respectively, (P<0.05). Postresection systemic vascular resistance (SVR) decreased significantly in both groups, but was better preserved with Des vs. TCI (836 ± 8 vs. 779 ± 36 dyn.sec.cm-5, P<0.01), this was reflected in higher mean blood pressure and stroke volumes (91 ± 3 vs. 81 ± 5 mmHg and 86 ± 3 ml vs. 78 ± 5 ml, respectively, P<0.01). Post-resection changes in GST and microalb were comparable between Des and TCI (GST: 441.0 ± 20.8 vs. 437.5 ± 22.2, IU/ml, P>0.05), (Microalb. 17.7 ± 2.5 vs. 18.64 ± 1.19, (μgm/ml) respectively, P>0.05). Des more economic than TCI (33.5 ± 8.2 vs. 69.1 ± 8.1 US Dollars), (P< 0.05) respectively during same surgical time and with comparable hemoglobin concentrations. Conclusion: Recovery was enhanced better with Desflurane. TED monitoring demonstrated a significant preservation of SVR and MABP post-resection with Des vs. TCI. Neither was superior to the other with respect to liver and kidney functions. Further studies on a larger scale are recommended.