The effects of N-acetylcysteine on hepatic function during isoflurane anaesthesia for laparoscopic surgery patients

Abstract

Introduction:Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aims to compare the antioxidant effects of isoflurane and N-acetylcysteine (NAC) on liver function.Methods:Forty-one patients in the ASA I-II risk groups, who were scheduled to undergo gynaecologic laparoscopy, were randomly divided into two groups: The placebo (group P, n=21) and the NAC group (group N, n=20). In both groups, anaesthesia was maintained with 1–2% isoflurane in 50% Oxygen–50% N2O at 6 l/min, also administered by inhalation. Venous blood samples were obtained before anaesthesia induction, and then in the postoperative 1st hour and at the 24th hour. The samples were centrifuged and serum levels of glutathione S-transferase (GST), malondialdehyde (MDA), aspartate amino transferase (AST), alanine amino transferase (ALT), lactate dehydrogenase (LDH), gamma glutamyltranspeptidase (GGT), prothrombin time (PT), activated partial thromboplastin time (aPTT) and international normalised ratio were determined.Results:GST levels were significantly higher in group N than in group P in the postoperative 1st hour. Postoperative values of GST in the two groups were higher when compared to preoperative values (P<0.05). When postoperative levels were compared with preoperative levels, the postoperative MDA levels of group N were significantly higher (P<0.05). Levels of AST, ALT, GGT and LDH in both groups revealed significant decreases at the postoperative 1st hour and postoperative 24th hour compared to preoperative values (P<0.05, P<0.001). PT values were significantly higher in both groups in the postoperative 1st hour and 24th hour (P<0.05, P<0.001), although there were no differences in aPTT levels.Conclusion:Our results showed that liver functions were well preserved with administration of NAC during anaesthesia with isoflurane. Isoflurane with NAC has lesser effect on liver function tests compared to isoflurane alone.

Effectiveness of intravenous infusion of N-acetylcysteine in cirrhotic patients undergoing major abdominal surgeries

“…who found that NAC preserved hepatic function during isoflurane anesthesia in laparoscopic surgery patients. [ 34 ] Todd Stravitz et al . showed that NAC may improve transplant-free survival in patients with nonacetaminophen ALF by ameliorating the production of IL-17.…”

Polymorphisms and allele frequencies of glutathione S-transferases A1 and P1 genes in the Polish population

“…The unique properties of this enzyme make it a more specific marker for hepatocellular impairment than the routinely used aminotransferases (aspartate and alanine aminotransferases) (Knapen et al, 2000). Therefore, this indicator has been widely analyzed for the hepatotoxic effect of different drugs such as anesthetics, nicardypine, and cimetidine, N-acetylcysteine (Ray et al, 1989a,b;Yousif et al, 2009;Beyaz et al, 2011).…”

Glutathione S-transferase as a toxicity indicator in general anesthesia: genetics and biochemical function

“…Moreover, GST level measurements were used in the analysis of particular substances' impact, for example, nicardypine, cimetidine, and N-acetylcysteine, on the toxicity of the inhaled anesthetic agents [26][27][28]. Administration of nicardipine before and during halothane anesthesia was used to test the possibility of decreasing the GST enzyme level released from hepatocytes.…”