Bispectral Index Monitoring in Healthy, Cirrhotic, and End-Stage Liver Disease Patients Undergoing Hepatic Operation

Wang, C.-H.; Chen, C.-L.; Cheng, K.-W.; Huang, Chung‐Cheng; Chen, K.-H.; Wang, C.-C.; Concejero, Allan M.; Cheng, Yu; Huang, Tung‐Liang; Chiu, King-Wah; Wang, S.-H.; Lin, Chia‐Yu; Liu, Y.-W.; Jawan, Bruno

doi:10.1016/j.transproceed.2008.07.031

Cited by 21 publications

(17 citation statements)

References 10 publications

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“…According to the results of a previous study, the end-tidal concentration of isoflurane required to maintain BIS values between 45 and 55 was lowest in end-stage liver disease patients undergoing LDLT (n = 7), intermediate in cirrhotic patients with hepatocellular carcinoma undergoing partial hepatectomy (n = 11), and highest in healthy liver donors (n = 11). [19] However, the small sample size and significantly younger age in the healthy liver donor group prevented drawing a clear conclusion about the relationship between anesthetic requirements and the severity of hepatic disease. Among patients undergoing orthotopic liver transplantation, patients with more severe liver disease (Model for End-stage Liver Disease [MELD] score ≥20, n = 25) required lower end-tidal desflurane concentrations to maintain BIS values between 40 and 50 in the absence of an opioid-induced analgesic effect than patients with less severe liver disease (MELD score <20, n = 25) during the preanhepatic and anhepatic phases, but the anesthetic requirements became comparable between the 2 groups during the neohepatic phase.…”

Section: Discussionmentioning

confidence: 99%

“…The absence of the liver could represent the nadir of hepatic function. Because poor hepatic function is associated with lower anesthetic requirements, [19,20] the anesthetic requirements are expected to be lower during the anhepatic phase than during the other 2 phases. Accordingly, the propofol target concentration required to maintain BIS values between 40 and 50, [12] the end-tidal isoflurane concentration required to maintain BIS values between 40 and 55, [11] and the end-tidal desflurane concentration required to maintain state and response entropy values between 40 and 60 [10] were lowest in the anhepatic phase than in the other phases.…”

Section: Discussionmentioning

confidence: 99%

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The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function

Son

Byun²,

Kim³

2016

Medicine

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Temporary portocaval shunt (TPCS) prolongs the duration of the anhepatic phase, during which anesthetic sensitivity is highest among the 3 phases of living donor liver transplantation (LDLT). Cognitive dysfunction has been associated with increased anesthetic sensitivity and poor hepatic function. Therefore, we assessed anesthetic sensitivity to desflurane and perioperative cognitive function in patients undergoing LDLT, in whom the duration of the anhepatic phase was extended by TPCS to test the hypothesis that the prolonged anhepatic phase increases anesthetic sensitivity and causes postoperative cognitive decline.This case–control study was conducted in 67 consecutive patients undergoing LDLT from February 2014 to January 2016. Anesthesia was maintained at a 0.6 end-tidal age-adjusted minimum alveolar concentration of desflurane. The bispectral index (BIS) was maintained at less than 60 and averaged at 1-minute intervals. The mini-mental state examination (MMSE-KC) was performed 1 day before and 7 days after the LDLT. All parameters were compared between the patients undergoing TPCS (TPCS group) and the remaining patients (non-TPCS group).TPCS was performed in 16 patients (24%). TPCS prolonged the duration of the anhepatic phase (125.9 ± 29.4 vs 54.9 ± 20.5 minutes [mean ± standard deviation], P < 0.0001). The averaged BIS values during the 3 phases were comparable between the 2 groups. No significant interval changes in the averaged BIS values were observed during the 3 consecutive phases. Similarly, there were no significant differences in MMSE-KC score assessed 1 day before and 7 days after LDLT between the 2 groups. The preoperative MMSE-KC scores were unchanged postoperatively in the 2 groups.The extension of the anhepatic phase did not affect anesthetic sensitivity and postoperative cognitive function.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function

Son

Byun²,

Kim³

2016

Medicine

View full text Add to dashboard Cite

show abstract

“…Therefore, anesthetic agents should be titrated with caution in cirrhotic patients to minimize the adverse effects of drugs and to stabilize hemodymanics. Recently, Wang, et al19 demonstrated that the worse the liver function, the least end-tidal concentration of isoflurane was required to achieve a preset target of BIS at 45-55. Although propofol is presently being used as a predominant hypnotic in clinical anesthesia practice, its pharmacological character in cirrhotic patients, especially in those patients with decompensated cirrhosis, is still not well known.…”

Section: Discussionmentioning

confidence: 99%

The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

Huang

Chen

et al. 2013

Yonsei Med J

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PurposeThe purpose of this study was to investigate the influence of chronic virus-related liver disease severity on propofol requirements.Materials and MethodsIn this study, 48 male patients with chronic hepatitis B infection were divided into three groups according to Child-Turcotte-Pugh classification of liver function (groups A, B, and C with mild, moderate and severe liver disease, respectively). After intubation, propofol concentration was adjusted by ±0.3 µg/mL increments to maintain bispectral index in the range of 40-60. Target propofol concentrations at anesthesia initiation, pre-intubation and pre-incision were recorded.ResultsThe initial concentration used in group C was significantly lower than that used in group A or B (p<0.05), whereas no difference was observed between groups A and B. At pre-intubation, the actual required concentration of propofol increased significantly (3.2 µg/mL) in group A (p<0.05), which lead to significant differences between the groups (p<0.05). At pre-incision, the requirements for propofol decreased significantly in both groups A and B (3.0 µg/mL and 2.7 µg/mL, respectively) compared with those at pre-intubation (p<0.05), and were significantly different for all three groups (p<0.05), with group C demonstrating the lowest requirement (2.2 µg/mL). The required concentrations of propofol at pre-incision were similar to those at induction.ConclusionIn this study, propofol requirements administered by target-controlled infusion to maintain similar depths of hypnosis were shown to depend on the severity of chronic virus-related liver dysfunction. In other words, patients with the most severe liver dysfunction required the least amount of propofol.

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“…[59] Anaesthetic requirements vary along with their MELD scores in different phases of liver transplantation. [60] Bispectral index (BIS) monitoring has been used in the peritransplant period to monitor consciousness and hence can be used intraoperatively to titrate the anaesthetic requirement.…”

Section: Intraoperative Monitoring and Managementmentioning

confidence: 99%

Liver transplantation: Advances and perioperative care

et al. 2012

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Liver transplantation is one of the treatments for many-life threatening liver diseases. Numerous advances in liver transplant surgery, anaesthesia and perioperative care have allowed for an increasing number of these procedures. The purpose of this review is to consider some of the important advances in perioperative care of liver transplant patients such as pre-operative evaluation, intraoperative monitoring and management and early extubation. A PubMed and EMBASE search of terms “Anaesthesia” and “Liver Transplantation” were performed with filters of articles in “English”, “Adult” and relevant recent publications of randomised control trial, editorial, systemic review and non-systemic review were selected and synthesized according to the author's personal and professional perspective in the field of liver transplantation and anaesthesia. The article outlines strategies in organ preservation, training and transplant database for further research.

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Bispectral Index Monitoring in Healthy, Cirrhotic, and End-Stage Liver Disease Patients Undergoing Hepatic Operation

Cited by 21 publications

References 10 publications

The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function

The anhepatic phase extended by temporary portocaval shunt does not affect anesthetic sensitivity and postoperative cognitive function

The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

Liver transplantation: Advances and perioperative care

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