A Comparison of Liver Function After Hepatectomy in Cirrhotic Patients Between Isoflurane Inhaled and Propofol Intravenous in Anesthesia with Epidural Block

Liver resection may require hepatic inflow occlusion (Pringle’s maneuver) to diminish intraoperative blood loss, thus may result in transient ischemia followed by reperfusion, which may initiate liver injury and lead to postoperative liver dysfunction. Many protective strategies against ischemia reperfusion (IR) injury in the liver have been proposed, including surgical interventions, use of pharmacologic agents, or gene therapy, however, none of these methods has found its way into routine clinical practice. Therefore, therapeutic strategies to prevent liver tissue damage after IR have become the focus of extensive research efforts. Recently, accumulating evidence suggests volatile anesthetics can attenuate liver IR injury through a mechanism of inducing some endogenous protective molecules such as heme-oxygenase (HO) enzyme system or hypoxia induced factor (HIF) etc, which suggest volatile anesthetics concerning pharmacological pretreatment would most likely be a hopeful way to prolonger the patient’s endurance to hepatic IR. Unfortunately, most of isoflurane hepatoprotection evidences and related mechanisms were based on the result of animal studies, as isoflurane are most clinically used anesthetic during liver resection worldwide. Since Pringle’s maneuver are commonly applied by most of surgeons in our center which also cause an inevitable liver damage perioperatively, therefore providing us an ideal clinic model of hepatic IR injury. In order to test our hypothesis that using volatile anesthetics isoflurane can attenuate live IR injury rather than intravenous propofol in hepatectomy patients. We designed this clinical randomized comparative study to observer hepatectomy patients’ postoperative outcome especially liver function recovery when they received isofluare inhaled anesthesia or propofol injection respectively. We also compared serum proinflammatory factor and liver histiopathologic changes between 2 groups.