The effect of propofol and desflurane anaesthesia on human hepatic blood flow: a pilot study*

Abstract

SummaryThis study tested the hypothesis that propofol is associated with a higher hepatic blood flow in humans compared with desflurane. Using a cross over study design, 10 patients received first propofol and then desflurane, and a further 10 patients received desflurane and then propofol. Blood flow index in the right and middle hepatic veins, stroke volume index and cardiac index were assessed by transoesophageal echocardiography. Mean arterial blood pressure, stroke volume index and cardiac index were the same in both groups. The liver is known to be susceptible to hypoxic damage in conditions that increase oxygen consumption or decrease oxygen supply [1][2][3]. In addition, it has been hypothesised that hypoperfusion of the liver may initiate or contribute to the development of a systemic inflammatory response syndrome potentially leading to multiple organ failure [4].Although the systemic haemodynamic effects of propofol have been extensively investigated, data about the effects of propofol on hepatic perfusion are scarce and equivocal. Interestingly, studies in rats, dogs, and rabbits have shown that propofol may increase in hepatic blood flow [5][6][7][8], an effect which is combined with a proportional increase in hepatic oxygen consumption [5,8]. These results are in contrast to those reported in one study of sheep and one of humans [9,10]. In these studies, using an indicator dye clearance technique to measure hepatic blood flow, the authors report a decrease in hepatic blood flow after propofol [9,10]. Propofol however, has been demonstrated to inhibit the hepatic clearance of the indicator dye indocyanine green [11], raising questions as to the validity of these results [5,12].Volatile anaesthetic agents, possibly with the exception of isoflurane, are known to induce a dose-dependent decrease in hepatic perfusion [1,13]. The dose-dependent decrease in hepatic perfusion has also been described for desflurane [14], a drug increasingly used because of its favourable pharmacokinetic properties.We hypothesised that propofol anaesthesia in humans is associated with a greater hepatic blood flow compared with desflurane anaesthesia. To test this hypothesis, we performed a randomised cross over designed study of 20 patients scheduled for elective surgery, using a Doppler sonographic technique to measure hepatic blood flow. MethodThe study was approved by the ethics committee of the University of Ulm. Twenty patients were enrolled

Effect of sevoflurane anaesthesia on hepatic blood flow in infants with obstructive hepatobiliary disease

“…Although inhaled anaesthesia may be associated with less hepatic blood flow than intravenous anaesthesia with propofol in adults, effects of sevoflurane anaesthesia on hepatic blood flow for infants with obstructive hepatobiliary disease are not clear. 16 Our finding provided clinical support that sevoflurane can be used without decreasing hepatic blood flow in this population.…”

Review article: prescribing medications in patients with cirrhosis – a practical guide

“…Among the choices for anaesthetics for liver transplant patients and those undergoing TIPS, factors such as the effects on hepatic blood flow figure prominently in the decision‐making process. In a study of 10 patients who first received propofol then desflurane, and a group of another 10 patients receiving desflurane then propofol, Meierhenrich et al . found that propofol anaesthesia was associated with significantly greater preservation of hepatic blood flow compared with desflurane.…”

Transient liver elastography in unsedated control children: Impact of age and intercurrent illness

“…It has been suggested to perform TE in younger children when they are sedated to overcome cooperation issues; however, this approach reduces the utility of outpatient and opportunistic study, and we have demonstrated that in the majority of children over 2 years, sedation is unnecessary. Moreover, general anaesthesia and sedation have been associated with falsely elevated LSM values, which might be explained by increased splanchnic blood flow and hence portal flow secondary to the use of propofol and desflurane . Factors such as intercurrent illness, sedation, large meals can lead to reduced specificity of an elevated reading, and these factors must be taken into account when performing TE.…”