Pilot study of closed-loop anaesthesia for liver transplantation

Restoux, Aymeric; Grassin-Delyle, Stanislas; Liu, N.; Paugam–Burtz, Catherine; Mantz, Jean; Guen, Morgan Le

doi:10.1093/bja/aew262

Cited by 9 publications

(4 citation statements)

References 33 publications

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“…BIS is used to measure the depth of anesthesia. In our study, when the patients lost consciousness, their BIS scores were approximately 60, which is similar to scores recorded after induction by propofol in other studies 36 . After the loss of patient consciousness, the Cep, onset time and BIS of propofol anesthesia can be used to evaluate susceptibility to propofol.…”

Section: Discussionsupporting

confidence: 90%

Association of Polymorphisms in Pharmacogenetic Candidate Genes with Propofol Susceptibility

Zhong

Chen

Zhao

et al. 2017

Sci Rep

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Significant individual susceptibility to intravenous anesthetic propofol exists. The etiology of individual variability in the response to propofol may be influenced by genetic polymorphisms in metabolic and functional pathways. With current pharmacogenetics and modern molecular biology technologies, it is possible to study the influence of genetic polymorphisms on susceptibility to propofol. When inducing general anesthesia with intravenous propofol, high individual susceptibility to propofol was found. Using Sequenom MassARRAY single-nucleotide polymorphism (SNP) genotyping, we identified a mutation (rs6313) in the 5HT2A gene that was correlated to individual susceptibility to propofol effect-site concentration (Cep) and onset time of propofol induction. Carriers of the minor allele (G) of 5HT2A rs6313 required less propofol (20% decrease in Cep) and less time (40% decrease in onset time) to induce anesthesia. Moreover, associations were found between the gamma-aminobutyric acid (GABA) receptor SNP rs2279020 and the SCN9A SNP rs6746030 and the susceptibility of bispectral index (BIS) after propofol-induced anesthesia. In addition, dominant mutations in GABAA1 rs2279020, GABAA2 rs11503014, and CHRM2 rs1824024 were putatively associated with cardiovascular susceptibility to propofol anesthesia. No gene-gene interactions were found through a standardized measure of linkage disequilibrium and a multifactor dimensionality reduction analysis. Our results suggest that genetic polymorphisms related to mechanisms of propofol anesthesia are involved in propofol susceptibility.

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Section: Discussionsupporting

confidence: 90%

Association of Polymorphisms in Pharmacogenetic Candidate Genes with Propofol Susceptibility

Zhong

Chen

Zhao

et al. 2017

Sci Rep

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“…Taken together, these factors make inhalational general anesthesia the preferred anesthetic for these cases as large fluctuations in blood volume do not influence inhalational levels of anesthetic vapor. Interestingly, propofol requirements are reduced under target-controlled infusionbased TIVA, particularly during the anhepatic phase of OLTx [9][10][11], at least partially due to higher measured propofol blood concentrations compared to the target level [7,11]. is is likely due to reduced clearance of propofol during the anhepatic phase.…”

Section: Discussionmentioning

confidence: 99%

Orthotopic Liver Transplantation in a Patient with Acutely Decompensated Liver Disease and Personal History of Malignant Hyperthermia

Townsend

Habibi

Groose

et al. 2022

Case Reports in Anesthesiology

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Introduction Orthotopic liver transplants are characterized by sudden changes in hemodynamics, intraoperative hemorrhage, metabolic and electrolyte derangements, and arrhythmias. Many of these features are also hallmarks of malignant hyperthermia episodes and make differentiation difficult intraoperatively. Additionally, the treatment for malignant hyperthermia, dantrolene, can cause hepatotoxicity in already damaged native livers and newly reperfused organ allografts. Thus, it is imperative to avoid a triggering anesthetic in these patients. Here we report on a successful total intravenous anesthetic in a malignant hyperthermia susceptible individual undergoing an orthotopic liver transplant for acutely decompensated end-stage liver disease. Case Presentation . A 49-year-old male with a past medical history significant for malignant hyperthermia episodes as a child was admitted with decompensated alcoholic cirrhosis. He underwent uneventful total intravenous general anesthesia with propofol and sufentanil continuous infusions for an orthotopic liver transplant. He required minimal vasoactive agents to maintain a mean arterial blood pressure >65 mmHg and was extubated on postoperative day 1. Conclusions Total intravenous anesthesia is necessary for patients with a personal history of malignant hyperthermia. However, this type of general anesthesia is difficult in the setting of fluctuating hemodynamics, hemorrhage, and changes in drug metabolism and clearance during the anhepatic and reperfusion phases of an orthotopic liver transplant. Propofol and sufentanil continuous infusions provided stable hemodynamics and an excellent plane of anesthesia throughout the case and should be considered in other individuals undergoing this procedure who require a total intravenous anesthetic.

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“…Details, set of rules and gains constant of the controller are provided in the appendix of a previously published article. [ 2 ] The controller has been used in several controlled studies, in particular a study of adult patients undergoing routine surgery with better efficacy than manual control, [ 2 ] and studies which adressed its efficacy in some specific populations (pediatrics, [ 13 ] obese patients), [ 14 ] or during some specific surgical interventions (lung transplantation, [ 15 ] liver transplantation, [ 16 ] and bronchoscopy), [ 17 ] or as a method to evaluate the anesthetic effect of a conversational hypnotic session [ 3 ] or of drugs (nitrous oxide, [ 4 ] dexmedetomidine), [ 5 ] or to evaluate the analgesic effect of intraoperative use of epidural analgesia. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

Nociceptive stimulation during Macintosh direct laryngoscopy compared with McGrath Mac videolaryngoscopy

et al. 2017

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Pilot study of closed-loop anaesthesia for liver transplantation

Abstract: This pilot study indicates that automated titration of propofol and remifentanil guided by the BIS is feasible during OLT.

Cited by 9 publications

References 33 publications

Association of Polymorphisms in Pharmacogenetic Candidate Genes with Propofol Susceptibility

Association of Polymorphisms in Pharmacogenetic Candidate Genes with Propofol Susceptibility

Orthotopic Liver Transplantation in a Patient with Acutely Decompensated Liver Disease and Personal History of Malignant Hyperthermia

Nociceptive stimulation during Macintosh direct laryngoscopy compared with McGrath Mac videolaryngoscopy

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