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

Abstract

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.

Portocaval shunt and its Implications for Liver Transplantation: An Integrative Literature Review

“…Only two studies, by Rayar et al 3 and Weniger et al, 18 found an increase surgical time in the group undergoing TPCS. In cases where there was an increase in the anhepatic phase in the TPCS group, as in the prospective study conducted by Son et al, 17 there was no impact on anesthetic sensitivity or postoperative cognitive function.…”

“…The same was seen in a retrospective study of Nacif et al, 16 while other authors reported that there was no difference. 2,7,15,17 According to Belghiti et al, 8 the average time to perform the shunt is 9 minutes, and for Faitot et al 9 the time varies between 5 and 15 minutes. Only two studies, by Rayar et al 3 and Weniger et al, 18 found an increase surgical time in the group undergoing TPCS.…”

Intraoperative Surgical Portosystemic Shunt in Liver Transplantation: Systematic Review and Meta-Analysis

“…Of these systematic reviews, we selected 28 cases to further assess. We analyzed all articles regarding liver transplantation [ 1 , 4 – 6 , 13 – 24 ], 3 articles describing HPCS [ 4 – 6 ], and 10 articles describing TPCS [ 1 , 13 – 18 , 20 , 23 , 24 ]. In Figure 2 we show the flow diagram of the systematic literature search, according to PRISMA statement.…”

Shunt Portocava y sus Implicaciones para el Transplante de Hígado: Una Revisión Integrativa de la Literatura

“…Lo mismo fue visto en estudio retrospectivo de Nacif et al, 16 mientras otros autores relataron que no hubo diferencia. 2,7,15,17 Según Belghiti et al, 8 el tiempo promedio para la realización del shunt es de 9 minutos, y para Faitot et al 9 el tiempo varía entre 5 y 15 minutos.…”