None listed
Conditions
Brief summary
Liver resection may require hepatic inflow occlusion (Pringle’s maneuver) to diminish intraoperative blood loss, thus may result in transient ischemia followed by reperfusion, which may initiate liver injury and lead to postoperative liver dysfunction. Many protective strategies against ischemia reperfusion (IR) injury in the liver have been proposed, including surgical interventions, use of pharmacologic agents, or gene therapy, however, none of these methods has found its way into routine clinical practice. Therefore, therapeutic strategies to prevent liver tissue damage after IR have become the focus of extensive research efforts. Recently, accumulating evidence suggests volatile anesthetics can attenuate liver IR injury through a mechanism of inducing some endogenous protective molecules such as heme-oxygenase (HO) enzyme system or hypoxia induced factor (HIF) etc, which suggest volatile anesthetics concerning pharmacological pretreatment would most likely be a hopeful way to prolonger the patient’s endurance to hepatic IR. Unfortunately, most of isoflurane hepatoprotection evidences and related mechanisms were based on the result of animal studies, as isoflurane are most clinically used anesthetic during liver resection worldwide. Since Pringle’s maneuver are commonly applied by most of surgeons in our center which also cause an inevitable liver damage perioperatively, therefore providing us an ideal clinic model of hepatic IR injury. In order to test our hypothesis that using volatile anesthetics isoflurane can attenuate live IR injury rather than intravenous propofol in hepatectomy patients. We designed this clinical randomized comparative study to observer hepatectomy patients’ postoperative outcome especially liver function recovery when they received isofluare inhaled anesthesia or propofol injection respectively. We also compared serum proinflammatory factor and liver histiopathologic changes between 2 groups.
Interventions
a) 1-1.5 minimum alveolar concentration (MAC) of isoflurane 1.15-1.75 % , the individual patient's dose is based on the clinical variables;
b) anaesthic administered from 30 minutes before commencement of surgery until completion of surgery (100-200 minutes in total)
c) the mode of administration: inhalation via tracheal tubing.
Sponsors
Shanghai Rising-Star Program (No 08QA14007)
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. Elective liver resection 2. American Society of Anesthesiologists (ASA) physical status II-III patients 3. Primary liver cancer patients who had history of hepatitis B related cirrhosis 4. undergoing combined general and epidural anesthesia
Exclusion criteria
1.Contradictions of epidural puncture including coagulate disorder (prothrombin time (PT) longer than 15 sec or/and blood platelets count less than 10,000) 2.Tumor size too large or small ( longitude of tumor was beyond 3-8 cm) or estimated blood loss was large than 1000 cc. 3.Individuals in whom the regional block failed and surgery was performed under general anesthesia alone were also withdrawn from the study. 4.Indivduals fail to be performed Pringer’s maneuver due to technologic problem.
Outcome results
None listed