TITLE

Effect of Propofol Fentanyl Anesthesia on Hepatocellular Integrity During Induced Hypotension

AUTHOR(S)
Omar, Sohaila H.; Dessouki, Abdallah M.; Osman, Emad S.; El Hadidy, Abla S.; Kamel, Hend H.; Samhan, Yasser M.
PUB. DATE
May 2008
SOURCE
Journal of Medical Sciences;2008, Vol. 8 Issue 3, p275
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
We undertook a study to evaluate the effects of propofol on hepatocellular integrity with or without nitroglycerin-induced hypotension using specific and sensitive markers of hepatic injury. In a randomized controlled study, thirty adult consented patients aged 22 to 55 years old scheduled for various urological procedures were allocated randomly to a nitroglycerin (NTG) or a control group (control) of fifteen patients each. Anesthesia was induced with fentanyl 2 µg kg and propofol 2 mg kg-1. For maintenance, propofol infusion 6-10 mg kg-1 h-1 and increments of fentanyl and atracurium were administered according to the monitored hemodynamic and neuromuscular responses, respectively. Induced hypotension was achieved in the NTG group using nitroglycerin infusion started at a rate of 0.5-1 µg kg-1 min-1 and adjusted to maintain a mean arterial pressure (MAP) of 50-65 mm Hg. Hepatic glutathione S-transferases (α-GST and π-GST), hyaluronic acid (HA), aspartate (AST) and alanine (ALT) aminotransferases were measured before anaesthesia (T0), 15 min (T1), 30 rain (T2), 60 min (T3) after reaching the target threshold of MAP and 24 h after the end of anesthesia (T4). The control group showed no significant changes in plasma α-GST and hyaluronic acid concentrations while the NTG group showed significantly higher levels in hyaluronic acid from T0 to T1 (p = 0.016), T2 (p = 0.007) and T3 (p = 0.003). Also, α-GST was increased significantly in the NTG group from T0 to T2 (p = 0.037) and T3 (p = 0.049). Both enzymes returned back to normal range 24 h after the procedures (T4). π-GST, AST and ALT showed no significant changes throughout the study period in both groups. Propofol fentanyl anesthesia had no effect on plasma concentrations of GST and hyaluronate either during or after surgery. The addition of hypotension is associated with a transient reversible increase in these enzymes reflecting a minor degree of impaired hepatocellular integrity.
ACCESSION #
35601038

 

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