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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2016 | Research article

Effect of the severity of liver dysfunction on the minimum alveolar concentration of sevoflurane responding to an electronic stimulation in cirrhotic patients

Authors: Yan Yin, Hong Xiao, Jirimutuya Han, Weiyi Zhang, Jianguo Cheng, Tao Zhu

Published in: BMC Anesthesiology | Issue 1/2015

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Abstract

Background

It has been observed that patients with liver dysfunction need lower dose anesthetic compared patients with normal liver function. The minimum amount of volatile anesthetic to achieve an optimal depth of anesthesia for these patients is still unclear. In this study, Minimum alveolar concentration (MAC) of the sevoflurane was determined using an electric stimulation and the effect of severity of liver dysfunction on the MAC was observed in cirrhotic patients.

Methods

Thirty patients undergoing upper abdominal surgery were divided into the following groups: group N (normal liver function), group A (Child-Pugh grade A) and group B (Child-Pugh grade B-C). Neuropsychological tests were performed before surgery. We measured MACelectric (minimum alveolar concentration that prevents movement in response to an electric stimulation in 50 % of patients) of sevoflurane in cirrhotic patients with liver dysfunction using an electrical stimulation of 80 mA at 50 Hz, and analyzed factors that associated change of MAC.

Results

According to the neuropsychological tests, there were 7 and 4 patients with minimal hepatic encephalopathy in Groups B and A, respectively. MACelectric in cirrhotic patients with liver dysfunction decreased significantly compared to that in healthy liver patients (1.51 ± 0.16 vol. %, 1.33 ± 0.14 vol. % and 1.17 ± 0.13 vol. % in Group N, A and B, respectively), while MACelectric was comparable between the cirrhotic patients with different Child-Pugh grade. The Alanine Aminotransferase (ALT) and baseline values of bispectral index (BIS) were risk factors associated with the lowering of MACelectric (p < 0.05).

Conclusion

MACelectric of sevoflurane in cirrhotic patients was significantly lower than that of patients with a healthy liver. The severity of liver dysfunction had no effect on the MACelectric of sevoflurane in cirrhotic patients.

Trial registration

This study has been registered in the Chinese Clinical Trial Register in August 3, 2011 (No. ChiCTR-TRC-11001507).
Literature
1.
Eger 2nd EI, Saidman LJ, Brandstater B. Minimum alveolar anesthetic concentration: a standard of anesthetic potency. Anesthesiology. 1965;26(6):756–63.PubMedCrossRef
2.
Doherty T, Redua MA, Queiroz‐Castro P, Egger C, Cox SK, Rohrbach BW. Effect of intravenous lidocaine and ketamine on the minimum alveolar concentration of isoflurane in goats. Vet Anaesth Analg. 2007;34(2):125–31.PubMedCrossRef
3.
Liu M, Hu X, Liu J. The effect of hypothermia on isoflurane MAC in children. Anesthesiology. 2001;94(3):429–32.PubMedCrossRef
4.
5.
Brian Jr JE, Bogan L, Kennedy RH, Seifen E. The impact of streptozotocin-induced diabetes on the minimum alveolar anesthetic concentration (MAC) of inhaled anesthetics in the rat. Anesth Analg. 1993;77(2):342–5.PubMedCrossRef
6.
Frei F, Haemmerle M, Brunner R, Kern C. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation. Anaesthesia. 1997;52(11):1056–60.PubMedCrossRef
7.
Hamp T, Krammel M, Weber U, Schmid R, Graf A, Plöchl W. The effect of a bolus dose of intravenous lidocaine on the minimum alveolar concentration of sevoflurane: a prospective, randomized, double-blinded, placebo-controlled trial. Anesth Analg. 2013;117(2):323–8.PubMedCrossRef
8.
Uddenfeldt P, Danielsson A. Primary biliary cirrhosis: survival of a cohort followed for 10 years. J Intern Med. 2000;248(4):292–8.PubMedCrossRef
9.
Ziser A, Plevak DJ, Wiesner RH, Rakela J, Offord KP, Brown DL. Morbidity and mortality in cirrhotic patients undergoing anesthesia and surgery. Anesthesiology. 1999;90(1):42–53.PubMedCrossRef
10.
Frye JW, Perri RE. Perioperative risk assessment for patients with cirrhosis and liver disease. Expert Rev Gastroenterol Hepatol. 2009;3(1):65–75.PubMedCrossRef
11.
Petsiti A, Tassoudis V, Vretzakis G, Zacharoulis D, Tepetes K, Ganeli G, Karanikolas M. Depth of anesthesia as a risk factor for perioperative morbidity. Anesthesiol Res Practive. 2015;2015:1–7.CrossRef
12.
Escallier K, Nadelson M, Zhou D, Avidan M. Monitoring the brain: processed electroencephalogram and peri‐operative outcomes. Anaesthesia. 2014;69(8):899–910.PubMedCrossRef
13.
Wang CH, Chen CL, Cheng KW, Huang CJ, Chen KH, Wang CC, Concejero AM, Cheng YF, Huang TL, Chiu KW, Wang SH, Lin CC, Liu YW, Jawan B. Bispectral index monitoring in healthy, cirrhotic, and end-stage liver disease patients undergoing hepatic operation. Transplant Proc. 2008;40(8):2489–91.PubMedCrossRef
14.
Yin Y, Yan M, Zhu T. Minimum alveolar concentration of sevoflurane in rabbits with liver fibrosis. Anesth Analg. 2012;114(3):561–5.PubMedCrossRef
15.
Kang JG, Ko JS, Kim GS, Gwak MS, Kim YR, Lee SK. The relationship between inhalational anesthetic requirements and the severity of liver disease in liver transplant recipients according to three phases of liver transplantation. Transplant Proc. 2010;42:854–857.PubMedCrossRef
16.
Pugh R, Murray‐Lyon I, Dawson J, Pietroni M, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60(8):646–9.PubMedCrossRef
17.
Zhong B, Chen M, Wang J, Yuan Y, Hu P. The value of number connection test in the diagnosis of subclinical hepatic encephalopathy. Zhonghua nei ke za zhi. 2001;40(1):13–5.PubMed
18.
Gong Y. China Revised Wechsler Adult Intelligence Scale Manual, vol. 2. Changsha: Hunan Cartographic Publishing House; 1992.
19.
Scheller MS, Saidman LJ, Partridge BL. MAC of sevoflurane in humans and the New Zealand white rabbit. Can J Anaesth. 1988;35(2):153–6.PubMedCrossRef
20.
Drummond J. MAC for halothane, enflurane, and isoflurane in the New Zealand white rabbit: and a test for the validity of MAC determinations. Anesthesiology. 1985;62(3):336–8.PubMedCrossRef
21.
Petersen-Felix S, Zbinden A, Fischer M, Thomson D. Isoflurane minimum alveolar concentration decreases during anesthesia and surgery. Anesthesiology. 1993;79(5):959–65.PubMedCrossRef
22.
23.
Franks N, Lieb W. Molecular and cellular mechanisms of general anaesthesia. Nature. 1994;367(6464):607–14.PubMedCrossRef
24.
Pocock G, Richards C. Excitatory and inhibitory synaptic mechanisms in anaesthesia. Br J Anaesth. 1993;71(1):134–47.PubMedCrossRef
25.
Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715–35.PubMedCrossRef
26.
Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002;35(3):716–21.PubMedCrossRef
27.
Das A, Dhiman RK, Saraswat VA, Verma M, Naik SR. Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis. J Gastroenterol Hepatol. 2001;16(5):531–5.PubMedCrossRef
28.
Groeneweg M, Moerland W, Quero JC, Hop WC, Krabbe PF, Schalm SW. Screening of subclinical hepatic encephalopathy. J Hepatol. 2000;32(5):748–53.PubMedCrossRef
29.
Jindal A, Sharma BC, Sachdeva S, Chawla R, Srivastava S, Maharshi S. Bispectral index monitoring for diagnosis and assessment of severity of hepatic encephalopathy in cirrhotic patients. Dig Liver Dis. 2015.
30.
Dahaba AA, Worm HC, Zhu S, Bao F, Salah A, Zakaria S, Bornemann H, Stadlbauer V, Rehak PH, Metzler H. Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy: a multicentre, observer blinded, validation study. Gut. 2008;57(1):77–83.PubMedCrossRef
31.
Kharasch E, Thummel K. Identification of cytochrome P450 2E1 as the predominant enzyme catalyzing human liver microsomal defluorination of sevoflurane, isoflurane, and methoxyflurane. Anesthesiology. 1993;79(4):795–807.PubMedCrossRef
32.
Farrell G, Cooksley W, Powell L. Drug metabolism in liver disease: activity of hepatic microsomal metabolizing enzymes. Clin Pharmacol Ther. 1979;26(4):483–92.PubMedCrossRef
33.
Farrell GC, Zaluzny L. Microsomal protein synthesis and induction of cytochrome P-450 in cirrhotic rat liver. Aust J Exp Biol Med Sci. 1984;62:291–301.PubMedCrossRef
34.
Gin T, Chan M. Decreased minimum alveolar concentration of isoflurane in pregnant humans. Anesthesiology. 1994;81(4):829–32.PubMedCrossRef
35.
Zbinden A, Petersen-Felix S, Thomson D. Anesthetic depth defined using multiple noxious stimuli during isoflurane/oxygen anesthesia. II. Hemodynamic responses. Anesthesiology. 1994;80(2):261–7.PubMedCrossRef
36.
Hornbein TF, Eger EI, Winter PM, Smith G, Wetstone D, Smith KH. The minimum alveolar concentration of nitrous oxide in man. Anesth Analg. 1982;61(7):553–6.PubMedCrossRef
37.
Jones R, Cashman J, EI Eger I, Damask M, Johnson B. Kinetics and potency of desflurane (I-653) in volunteers. Anesth Analg. 1990;70(1):3–7.PubMedCrossRef
38.
Schultz A, Katz R, Pavlin E. A comparison of ulnar nerve tetanic stimulation and clamping of anterior axillary fold to surgical incision for the determination of MAC. Anesthesiology. 1987;67:A669.CrossRef
Metadata
Title
Effect of the severity of liver dysfunction on the minimum alveolar concentration of sevoflurane responding to an electronic stimulation in cirrhotic patients
Authors
Yan Yin
Hong Xiao
Jirimutuya Han
Weiyi Zhang
Jianguo Cheng
Tao Zhu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-016-0260-8

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