Sevoflurane Or Propofol And Remifentanil For Maintenance Of Anesthesia On Hepatic Ischemia/Reperfusion Injury

Objective:In this study, compared with sevoflurane-remifentanil or propofol-remifentanil in the right hepatic tumor resection on hepatic ischemia/ reperfusion injury.Methods:anesthesia for elective resection of the right liver total hepatic occlusion parallel 30 patients aged 40-60 years old, weighing 50-70 kg, ASAⅠorⅡlevel, liver function Child A class. We randomly divided into 2 groups: propofol maintenance group (P group) and sevoflurane group (S group),15 cases each. Anesthesia was induced in both groups:intravenous injection of midazolam 0.05 mg/kg, fentanyl 4ug/kg, etomidate 0.3 mg/kg and 0.4mg/kg atracurium anesthesia was induced, tracheal plug underwent mechanical ventilation tube. Maintenance of anesthesia in group P:propofol (plasma target 3.5-4.5 ng/ml), and atracurium 0.2mg/kg/h; S group, anesthesia was maintained: 2.0%-3.5% inhaled sevoflurane, target-controlled infusion of remifentanil (target plasma concentration of 3.5-4.5ng/ml) and atracurium 0.2 mg/kg/h. Before induction of anesthesia (To), immediately after the opening of hepatic portal (T1), 30munite (T2),6 hour (T3), postoperative day (T4), three days after surgery (T5), after five days (T6) a left radial artery blood samples, the measured serum interleukin (TL-1β), tumor necrosis factor (TFN-α), alanine aminotransferase (ALT), aspartate aminotransferase (AST)levels and total superoxide dismutase (SOD) content.Results:Two general, portal triad clamping time and blood loss was not statistically significant comparison (P> 0.05). In this study, no patients were death in the perioperative. The two groups at each time point MAP, HR, and CVP was no significant difference (P> 0.05). Comparison between the two groups, ALT, AST, TNF-αeach time point was no significant difference (P> 0.05). IL-1βin the T3 time point difference was statistically significant (P<0.05), S group than P group. P group, S group comparison group, ALT, AST: Compared with To, T3, T4, T5, T6 time point value increased, the difference was statistically significant (P<0.05), And two groups of ALT, AST at the time point T5 highest; T-SOD:Compared with To, T4, T5, T6 time point values decreased significantly (P<0.05); TNF-α:Compared with To, P group, T2, T3, T4, T5, T6 time point value increased, the difference was statistically significant (P<0.05), S group, T2, T3, T4, T5 point value increased, the difference was statistically significant (P<0.05), and the two groups in the highest point of time T3; IL-1β: Compared with T0, the time value increased significantly (P<0.05), and the two time points in the value of T3 the highest.Conclusions:1. In the right lobe tumor resection and hepatic ischemia/ reperfusion injury cases, sevoflurane-remifentanil and propofol-remifentanil on ALT, AST, TNF-α. SOD no significant impact differences.2. Propofol remifentanil and sevoflurane-Comparison of remifentanil can reduce the production of IL-1β.