Perioperative effects of desflurane versus propofol on hemostasis guided by thromboelastometry in splenectomy with liver cirrhosis

Abstract

Background: Cirrhotic patients have impaired hemostasis with variable incidence of hypersplenism necessitating splenectomy. Rotation thromboelastometery (ROTEM) facilitates diagnosis and guides management. This study evaluates perioperative effects of desflurane versus propofol on hemostasis in cirrhotic patients undergoing splenectomy guided by ROTEM and laboratory hemostatic tests. Methods: Thirty hepatic Child A patients, ASA II-III, of either sex, aged 25-55 years, undergoing splenectomy were randomly allocated into two equal groups: Group D; anesthetized with desflurane 1 MAC (6%) and Group P; with propofol Target Controlled Infusion 2-5 µg/ml. Six blood samples were collected; preoperatively, after splenic artery ligation, immediately, first, third postoperative day then one month later. The samples were handled to measure complete blood picture, liver and kidney functions, screening coagulation tests (INR, PT and PTT), specific hemostatic factors (P-Selectin/CD62P, fibrinogen and D-dimer) as well as ROTEM criteria; clotting time (CT), clot formation time (CFT) and maximum clot firmness (MCF) via EX-TEM, IN-TEM and FIB-TEM commercial kits. Results: This study displayed postoperative hemoglobin reduction; however, platelet and WBCs as well as CT, CFT and MCF increased versus baseline. Screening and specific hemostatic factors as all other changes were within reference range and comparable between both groups. Conclusions: The current study concluded comparable effects of desflurane and propofol anesthesia on coagulation parameters within acceptable range as monitored by ROTEM and laboratory coagulation tests in cirrhotic patients with hypersplenism. Thus both anesthetics are considered safe in such patients who have high incidence of coagulopathy.

Impact of desflurane versus sevoflurane on coagulation in radical cystectomy patients

“…ALT and AST showed statistically significant increase in postoperative values compared to preoperative values in both sevoflurane and desflurane groups. In line with our study, Khafagy et al (8) investigated the effect of desflurane versus propofol with total intravenous anesthesia (TIVA Both studies, ours and Khafagy, the changes detected were all within the normal reference range. Their study also showed that PT & INR, were increased immediate postoperative then decreased 24 hours postoperative.…”

“…On the contrary, in our study, both fibrinogen and platelets decreased immediate postoperative, then further decreased 24 hours postoperative. The difference between Khafagy's study and ours may be due to differences in the type of patient as Khafagy et al (8) , did their in patients with livercirrhosis who were being scheduled for splenectomy, which may explain the postoperative increase in platelet counts. Khafagy et al (8) detected immediate postoperative reduction of hemoglobin, followed by a further 24-hour postoperative decrease.…”

“…The difference between Khafagy's study and ours may be due to differences in the type of patient as Khafagy et al (8) , did their in patients with livercirrhosis who were being scheduled for splenectomy, which may explain the postoperative increase in platelet counts. Khafagy et al (8) detected immediate postoperative reduction of hemoglobin, followed by a further 24-hour postoperative decrease. Both anesthetics were therefore considered safe in those patients with a high incidence of coagulopathy.…”