Comparing Intraoperative End-Tidal Sevoflurane Concentration in Cirrhosis to Non-cirrhosis Patients Undergoing Open Hepatic Resection

Abstract

Background: The effect of hepatic cirrhosis on anesthetic requirement is still uncertain. Some studies showed that, end stage hepatic disease or cirrhotic patients might have less inhalational anesthetic requirement than patients with normal hepatic function. In this study, during major hepatic resection, end-tidal sevoflurane concentration was compared between cirrhosis and non-cirrhosis patients. Methods: Our prospective observational study included 30 patients with hepatic tumors undergoing open major hepatic resection. The patients were divided into two groups: cirrhosis group (n=15) and non-cirrhosis group (n=15). Thoracic epidural combined with general anesthesia was performed. End tidal sevoflurane concentration was adjusted with target BIS between 40-55. Morphine and lidocaine were given via epidural catheter for pain control during perioperative periods. The primary outcome of the study is mean end-tidal sevoflurane. Demographic data including age, sex, weight, ASA physical status and other secondary outcomes were obtained from anesthetic records. Results: The mean end-tidal sevoflurane concentration was 1.59±0.23 vol.% in cirrhosis group and 1.67±0.19 vol.% in non-cirrhosis group (P=0.329). Minimal alveolar concentration (MAC) in cirrhosis group and non-cirrhosis group were 0.84±0.10 and 0.87±0.07 (P=0.330), respectively. There is no significant difference in demographic data except for the ASA status (P=0.002) and the duration of operation (P=0.033). Conclusion: Our study shows that there is no difference in end-tidal sevoflurane concentration, minimal alveolar concentration between cirrhosis and non-cirrhosis.