Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial

Yasmeen Abdelsalam Kamel; Noura Adel Ghareeb Sasa; Safaa Mohamed Helal; Hatem Amin Attallah; Khaled A Yassen

doi:10.4103/joacp.joacp_168_21

Monitoring the effects of automated gas control of sevoflurane versus target-guided propofol infusion on hemodynamics of liver patients during liver resection. A randomized controlled trial

J Anaesthesiol Clin Pharmacol. 2023 Jan-Mar;39(1):74-83. doi: 10.4103/joacp.joacp_168_21. Epub 2022 Jan 10.

Authors

Yasmeen Abdelsalam Kamel¹, Noura Adel Ghareeb Sasa¹, Safaa Mohamed Helal², Hatem Amin Attallah², Khaled A Yassen^{1

3}

Affiliations

¹ Department of Anesthesia and Intensive Care, National Liver Institute, Menoufia University, Egypt.
² Department Anesthesia and Intensive Care, Faculty of Medicine, Menoufia University, Egypt.
³ Department of Anesthesia Division-Surgery, College of Medicine, King Faisal University, Al Hasa, Saudi Arabia.

Abstract

Background and aims: Cirrhotic patients are prone to hypotension during anesthesia. The primary aim of the study was to compare the effects of automated gas control (AGC) of sevoflurane and target-controlled infusion (TCI) of propofol on systemic and cardiac hemodynamics in hepatitis C cirrhotic patients undergoing surgery. The secondary aim was to compare the recovery, complications, and costs between the two groups.

Material and methods: This was a randomized controlled trial in adults with hepatitis C cirrhosis (Child A) who underwent open liver resection and received AGC (n = 25) or TCI (n = 25). AGC was initially set at FiO₂ 40% and end-tidal sevoflurane (ET SEVO) at 2.0% with a fresh gas flow of 300 mL/min. TCI of propofol was given using Marsh pharmacokinetic mode with an initial propofol target concentration (Cpt) of 4 μg/mL. Bispectral index score (BIS) was maintained between 40 and 60. Invasive arterial blood pressure (IBP), electrical cardiometry (EC), cardiac output (CO), and systemic vascular resistance (SVR), Fi SEVO, ET SEVO, propofol Cpt, and effect-site concentration (Ce) were recorded.

Results: IBP and EC CO, and SVR were least affected by TCI propofol. Only one (4.00%) patient required vasopressors with TCI vs. 4 (16.00%) with AGC (χ² _{(Y) (df = 1)} = 0.88, P _(Y) = 0.34). There was no delayed recovery, hypoxia, or awareness; however, ICU stay was shorter with TCI, (P = 0.006). BIS and EC guided median of ET SEVO was 1.90%, Fi SEVO was 2.10% with AGC, and propofol Cpt and Ce were 3.00 μg/dL with TCI. Only 0.14 [0.12-0.15] mL/min of SEVO was consumed with AGC and 0.87 [0.85-0.97] mL/min propofol with TCI. The cost was higher with TCI, P < 0.00.

Conclusions: Both techniques are well tolerated hemodynamically, but TCI-propofol was found to be hemodynamically better. The recovery and complications were comparable in both groups, but TCI Propofol infusion was costlier.

Keywords: Anesthesia; cirrhosis; economic; hepatectomy; liver.