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Open Access 01-12-2020 | Sevoflurane | Research article

Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial

Authors: Jurgen van Limmen, Piet Wyffels, Frederik Berrevoet, Aude Vanlander, Laurent Coeman, Patrick Wouters, Stefan De Hert, Luc De Baerdemaeker

Published in: BMC Anesthesiology | Issue 1/2020

Abstract

Background

Maintaining adequate perioperative hepatic blood flow (HBF) supply is essential for preservation of postoperative normal liver function. Propofol and sevoflurane affect arterial and portal HBF. Previous studies have suggested that propofol increases total HBF, primarily by increasing portal HBF, while sevoflurane has only minimal effect on total HBF. Primary objective was to compare the effect of propofol (group P) and sevoflurane (group S) on arterial, portal and total HBF and on the caval and portal vein pressure during major abdominal surgery. The study was performed in patients undergoing pancreaticoduodenectomy because - in contrast to hepatic surgical procedures - this is a standardized surgical procedure without potential anticipated severe hemodynamic disturbances, and it allows direct access to the hepatic blood vessels.

Methods

Patients were randomized according to the type of anesthetic drug used. For both groups, Bispectral Index (BIS) monitoring was used to monitor depth of anesthesia. All patients received goal-directed hemodynamic therapy (GDHT) guided by the transpulmonary thermodilution technique. Hemodynamic data were measured, recorded and guided by Pulsioflex™. Arterial, portal and total HBF were measured directly, using ultrasound transit time flow measurements (TTFM) and were related to hemodynamic variables.

Results

Eighteen patients were included. There was no significant difference between groups in arterial, portal and total HBF. As a result of the GDHT, pre-set hemodynamic targets were obtained in both groups, but MAP was significantly lower in group S (p = 0.01). In order to obtain these pre-set hemodynamic targets, group S necessitated a significantly higher need for vasopressor support (p < 0.01).

Conclusion

Hepatic blood flow was similar under a propofol-based and a sevoflurane-based anesthetic regimen. Related to the application of GDHT, pre-set hemodynamic goals were maintained in both groups, but sevoflurane-anaesthetized patients had a significantly higher need for vasopressor support.

Trial registration

Study protocol number is AGO/2017/002 – EC/2017/0164. EudraCT number is 2017–000071-90.Clin.trail.gov,NCT03772106, Registered 4/12/2018, retrospective registered.

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Title: Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial
Authors: Jurgen van Limmen
Piet Wyffels
Frederik Berrevoet
Aude Vanlander
Laurent Coeman
Patrick Wouters
Stefan De Hert
Luc De Baerdemaeker
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Sevoflurane
Propofol
Published in: BMC Anesthesiology / Issue 1/2020
Electronic ISSN: 1471-2253
DOI: https://doi.org/10.1186/s12871-020-01150-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of propofol and sevoflurane on hepatic blood flow: a randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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