Effects Of Sevoflurane Preconditioning On Hepatic Ischemia Reperfusion Injury And Renal Funtion

Objective： to study the effects of sevoflurane preconditioning in the rightliver resection on hepatorenal function.Method：30patients undergoing liver sugery with inflow occlusion wereelectived in this study,all patients meet to following conditions: AmericanSociety of Anesthesiologists score II-III, liver function of Child score as A.30patients were randomly divided into2groups (n=15), sevofluranepreconditioning group (group S) and propofol control group (group P). Twogroups of induction of anesthesia with target controlled infusion of propofol for(3.0-4.0μg/ml), remifentanil for (3.0-4.0ng/ml) and injection withcisatracurium besilate base of0.2mg/kg. Maintenance of anesthesia: propofolcontrol group (group P) were sustained target-controlled infusion of propofol(3.0-4.0μg/ml), remifentanil (3.0-4.5ng/ml), and injection with cisatracuriumbesilate base of0.1mg/kg/h; sevoflurane preconditioning group (group S),2%sevoflurane for30minutes inhalation were giving before inflow occlusion, allthe same time target controlled infusion of remifentanil (3.0-4.5ng/ml), afterthat target-controlled infusion of propofol (3.0-4.0μg/ml), remifentanil (3.0-4.5ng/ml),and injection with cisatracurium besilate0.1mg/kg*h. Beforethe end of operation two groups were given fentanyl3μg/kg. Serum alanineaminotransferase (ALT), aspartate aminotransferase (AST), nitric oxide NO,blood urea nitrogen (BUN), creatinine (Cr) and superoxide dismutase (SOD)content were measured at each time In before induction of anesthesia (T0),hepatic inflow occlusion immediate (T1), ischemia reperfusion one hours (T2),ischemia reperfusion one day (T3).Result：1. The two groups in general, tumor size, hepatic inflow occlusion time,bleeding of operation,urine output were no statistical difference(P>0.05).2.Comparison between two groups: T0, T1, T2, T3each time point ofSOD,BUN, Cr were no statistical difference (P>0.05).2.1.AST, ALT, NO in T0, T1two time points showed no significantdifference (P>0.05); AST, ALT, NO in T2, T3two time points werestatistically significant differences (P <0.05), AST, ALT, P group was higherthan that of S group; NO, P group was lower than that of S group.3. In the two group comparison:3.1In group P, group S：SOD, BUN, Cr each time point of comparison hadno statistical difference (P>0.05).3.2In group P: AST, ALT compare to T0，T1were no statisticaldifference(P>0.05), while in T2, T3were gradually increased (P <0.05). Ingroup P：NO in comparison with T0，T1were not statistically different;T2,T3were statistical difference (P <0.05).T2,T3is less than T0(P <0.05).T2lessthan T3(P <0.05).3.3In group S: AST, ALT compare to T0， T1were no statisticaldifference(P>0.05), while in T2, T3were gradually increased (P <0.05). In group P：NO in comparison with T0，T1were not statistically different;T2,T3were statistical difference (P <0.05).T2,T3is less than T0(P <0.05).T2lessthan T3(P <0.05).Conclusion：1.sevoflurane preconditioning combined with propofol anesthesia canfurther reduce the hepatic ischemia reperfusion injury, which may be associatedwith increased during reperfusion on NO generation.2.sevoflurane preconditioning combined with propofol anesthesia orpropofol anesthesia had no significant impact on renal function.