Bispectral Index Monitoring to Guide End-Tidal Isoflurane Concentration at Three Phases of Operation in Patients With End-Stage Liver Disease Undergoing Orthotopic Liver Transplantation

Toprak, Hüseyin; Şener, Ali; Gedik, Ender; Uçar, Muharrem; Karahan, K.; Aydoğan, Mustafa Said; Ersoy, M. Özcan

doi:10.1016/j.transproceed.2010.11.023

Cited by 14 publications

(12 citation statements)

References 7 publications

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“…Interestingly, the average duration of the anhepatic phase extended by TPCS (125.9 minutes) was shorter than the average durations (159 [11] and 195 [10] minutes, respectively) found in previous studies, in which TPCS was not applied. The shorter duration of the anhepatic phase could not provide sufficient time to produce the effects of the anhepatic phase on anesthetic sensitivity, thereby creating the insignificant results in the present study.…”

Section: Discussioncontrasting

confidence: 69%

“…In addition to differences in the methods of anesthetic administration, the insignificant change in anesthetic sensitivity during the 3 phases and its insignificant difference between the 2 groups in the present study might have arisen from the difference in the duration of the anhepatic phase between ours and previous studies [10,11] with data regarding the duration of the anhepatic phase. Interestingly, the average duration of the anhepatic phase extended by TPCS (125.9 minutes) was shorter than the average durations (159 [11] and 195 [10] minutes, respectively) found in previous studies, in which TPCS was not applied.…”

Section: Discussioncontrasting

confidence: 67%

“…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%

See 2 more Smart Citations

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: Discussioncontrasting

confidence: 69%

Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…24 27 28 Use of a halogenated agent is modified less than propofol during the anhepatic phase. Toprak and colleagues 29 showed that the end-tidal concentration of isoflurane values required to maintain BIS within the target of 40 to 55, is lowest in the anhepatic phase compared with other phases, but the differences were not clinically relevant.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of closed-loop anaesthesia for liver transplantation

Restoux

Grassin-Delyle

Liu

et al. 2016

British Journal of Anaesthesia

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“…It has been shown that anesthetic requirements during liver transplantation are inversely proportional to the degree of hepatic dysfunction 111 , so careful titration of anesthetic doses with monitors like BIS© can minimize the negative cardiovascular effects of these drugs 112 . Isoflurane seems to be the most adequate halogenated agent, because it has few hemodynamic effects, lacks hepatotoxicity and protects hepatocytes from graft reperfusion injury [113][114] .…”

mentioning

confidence: 99%