Indocyanine Green Clearance and Hepatic Function During and After Prolonged Anaesthesia: Comparison of Halothane With Isoflurane

Abstract

Specific biochemical and physiological tests of liver function were used to assess 20 consecutive patients undergoing prolonged head and neck surgery with halothane or isoflurane anaesthesia. Hepatic function was assessed by measurement of serum concentrations of total bilirubin and albumin, and plasma activity of pseudocholinesterase, gamma-glutamyl transferase (GGT), aspartate transaminase (AST), alkaline phosphatase (ALP) and hepatic glutathione S-transferase. Plasma clearance of indocyanine green was used as an estimate of hepatic blood flow. No major differences were observed in serum concentrations of GGT, ALP, bilirubin, albumin or pseudocholinesterase. Serum AST activity in those patients receiving halothane was increased at 24 h and at 48 h compared with those who received isoflurane (not statistically significant). Glutathione S-transferase activity was increased significantly in the halothane group throughout the period of study, compared with those who received isoflurane. Similarly, there was a significant difference between the two groups as measured by plasma clearance of indocyanine green: in the halothane group there was a slower disappearance rate of the dye from plasma at specific times than in the patients who received isoflurane. Our data support the use of isoflurane rather than halothane for prolonged anaesthesia.

The Postoperative Effects of Halothane Versus Isoflurane on Hepatic Artery and Portal Vein Blood Flow in Humans

“…THBF in our patients was slightly less than has been reported in previous studies using ICG clearance and extraction in awake patients (14), and this may be related to anesthesia induction and maintenance (7). Liver blood flow values cannot be determined from studies that rely only on the rate of disappearance of ICG (22,23). Animal studies have indicated that halothane interferes with the capacity of the liver to metabolize certain drugs (24), including ICG (2), so the accuracy of using this dye to assess liver blood flow during inhaled anesthesia may be questionable.…”

Antioxidant status and lipid peroxidation activity in evaluating hepatocellular damage in children

“…In contrast, GST-α has been found to be equally distributed in both these regions [4]. Centrilobular hepatocytes are very susceptible to damage in a variety of clinical conditions including allograft rejection [7], viral hepatitis [8], chronic active hepatitis [9] and hepatotoxicity [10].…”

Anesthetic Considerations in Patients With Hepatic Failure

“…The biggest exception to this compensatory response of most volatile anesthetics is halothane, which appears to lyse this reflex arc and causes a decrease in both PBF and HABF, 51 decreasing hepatic perfusion and worsening liver damage. 52 For this reason, halothane is not recommended for patients with liver disease. Newer volatile agents such as sevoflurane 53 and desflurane 54 appear to compare favorably with isoflurane, and a choice between these 3 volatile anesthetics may be made on factors other than hepatic protection.…”