Effects of inhaled anesthetics on liver function of patients with toxic hepatitis undergoing surgery for pulmonary tuberculosis

Skorokhod K.V.; Volchkov V.A.; Li V.F.; Tronza V.S.

doi:https://doi.org/10.17116/anaesthesiology202102190

Skorokhod K.V.

St. Petersburg State University;
St. Petersburg Research Institute of Phthisiopulmonology

Volchkov V.A.

St. Petersburg State University;
St. Petersburg City Multi-field Hospital No. 2

ORCID: 0000-0002-5664-7386

Li V.F.

St. Petersburg Research Institute of Phthisiopulmonology

Tronza V.S.

Mechnikov North-Western State Medical University

Effects of inhaled anesthetics on liver function of patients with toxic hepatitis undergoing surgery for pulmonary tuberculosis

Authors:

Skorokhod K.V., Volchkov V.A., Li V.F., Tronza V.S.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2021;(2): 90‑97

DOI: 10.17116/anaesthesiology202102190

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To cite this article:

Skorokhod KV, Volchkov VA, Li VF, Tronza VS. Effects of inhaled anesthetics on liver function of patients with toxic hepatitis undergoing surgery for pulmonary tuberculosis. Russian Journal of Anesthesiology and Reanimatology. 2021;(2):90‑97. (In Russ.)
https://doi.org/10.17116/anaesthesiology202102190

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OBJECTIVE

To evaluate the influence of inhaled anesthetics (sevoflurane and desflurane) on liver function in patients with toxic hepatitis after anti-TB chemotherapy undergoing surgery for pulmonary tuberculosis.

MATERIAL AND METHODS

The study included 71 patients with toxic hepatitis undergoing surgery for pulmonary tuberculosis. All patients were divided into 3 groups depending on anesthetic: desflurane (group D), sevoflurane (group S) and propofol (group P). The last one was control group. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), alkaline phosphatase (ALP), γ-glutamyl transpeptidase (GGTP), lactate dehydrogenase (LDH), α-glutathione S-transferase (α-GST) were measured prior to surgery, in 1, 6, 24 hours, 7 and 14 days after surgery. Also, before induction, during the main stages of the operation, invasive monitoring of hemodynamics was performed using thermodilution technique by the PICCO device in order to exclude intraoperative ischemic injury of the liver.

RESULTS

Baseline ALT, AST, and α-GST exceeded the norm by 2-3 times. These values were comparable in all groups (p>0.05). A tendency to increase of α-GST in hour after surgery was observed in groups D and P, decrease of this enzyme — in group S (p>0.05). ALT and AST levels did not significantly increase in any group at all measurement points. ALP, GGTP and total bilirubin were normal throughout the study. LDH level was significantly higher after 24 hours in the desflurane group (p=0.02).

CONCLUSION

Inhaled anesthetics (sevoflurane and desflurane) along with propofol do not worsen liver function in patients with toxic hepatitis in early and delayed postoperative period.

Keywords:

toxic hepatitis

drug-induced liver injury

inhalation anesthesia

liver dysfunction and anesthesia

propofol

Authors:

Skorokhod K.V.

St. Petersburg State University;
St. Petersburg Research Institute of Phthisiopulmonology

Volchkov V.A.

St. Petersburg State University;
St. Petersburg City Multi-field Hospital No. 2

ORCID: 0000-0002-5664-7386

Li V.F.

St. Petersburg Research Institute of Phthisiopulmonology

Tronza V.S.

Mechnikov North-Western State Medical University

Received:

11.07.2020

Accepted:

13.10.2020

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References:

World Health Organization. Global Tuberculosis Report 2017. World Health Organization; 2017. Accessed January 10, 2021. https://www.who.int/tb/publications/global_report/gtbr2017_main_text.pdf
Volf SB, Sukhanov DS, Romantsov MG. Drug-induced liver injuries in polychemotherapy of tuberculosis. Vestnik Sankt-Peterburgskoj meditsinskoj akademii im. I.I. Mechnikova. 2009;30(1):172-176. (In Russ.).
Perelman MI, Naumov VN, Dobkin VG, Streltsov VP, Dubrovsky AV. Indications for surgical treatment of patients with pulmonary tuberculosis. Problemy tuberkuleza i boleznej legkikh. 2002;79(2):51-55. (In Russ.).
Lin J, Moore D, Hockey B, Rachel Di Lernia, Gorelik A, Liew D, Nicoll A. Drug-induced hepatotoxity: incidence of abnormal liver function tests consistent with volatile anesthetic hepatitis in trauma patients. Liver International. 2014;34(4):576-582. https://doi.org/10.1111/liv.12278
Safari S, Motavaf M, Seyed Siamdoust SA, Alavian SM. Hepatotoxity of halogenated inhalational anesthetics. Iran Red Crescent Medical Journal. 2014;16(9):e20153. https://doi.org/10.5812/ircmj.20153
Martin JL, Plevak DJ, Flannery KD, Charlton M, Poterucha JJ, Humphreys CE, Derfus G, Pohl LR. Hepatotoxicity after desflurane anesthesia. Anesthesiology. 1995;83(5):1125-1129. https://doi.org/10.1097/00132586-199610000-00047
Berghaus TM, Baron A, Geier A, Lamerz R, Paumgartner G. Hepatotoxity following desflurane anesthesia. Hepatology. 1999;29(2):613-614. https://doi.org/10.1002/hep.510290211
Nelson T. Desflurane-induced hepatitis. Internet Journal of Anesthesiology. 2012; 30 (3).
Tung D, Yoshida E. Severe desflurane hepatotoxicity after colon surgery in an elderly patient. Canadian Journal of Anesthesia. 2005;52(2):133-136. https://doi.org/10.1007/bf03027717
Higuchi H, Adachi Y, Wada H, Kanno M, Satoh T. Comparison of plasma α glutathione S-transferase concentrations during and after low-flow sevoflurane or isoflurane anaesthesia. Acta Anaesthesiologica Scandinavica. 2001;45(10):1226-1229. https://doi.org/10.1034/j.1399-6576.2001.451009.x
Rajan S, Garg D, Cummings KC III, Krishnaney AA. Hepatotoxity after sevoflurane anaesthesia: a new twist to an old story. British Journal of Anaesthesia. 2019;122(4):63-64. https://doi.org/10.1016/j.bja.2019.01.003
Zabolotskikh IB, Gromova EG, Lebedinskii KM, Lubnin AYu, Osovskikh VV, Sinkov SV, Khoroshilov SE, Schegolev AV. Perioperative management of patients with concomitant liver diseases. Anesteziologiya i Reanimatologiya. 2018;1-2:39-57. (In Russ.). https://doi.org/10.17116/anaesthesiology201801-02139
Repin YuM, Avetisyan AO, Elkin AV, Otten TF, Ryasnyanskaya TV, Trofimov MA. The importance of drug resistance of mycobacteria in the surgery of pulmonary tuberculosis. Problemy tuberkuleza. 2001;78(9):6-9. (In Russ.).
Ots ON, Sinitsyn MV, Semenov GI, Latyshev AN, Agkatsev TV, Kessel MM. Surgery of tuberculosis of the respiratory organs in the research Institute of Phthisiopulmonology of the I.M. Sechenov MMA: history and current trends. Tuberkulez i bolezni legkikh. 2009;86(12):11-21. (In Russ.).
Soleimanpour H, Safari S, Rahmani F, Hoorolnesa A, Alavian SM. The role of inhalational anesthetic drugs in patients with hepatic dysfunction: a review article. Anesthesiology and Pain Medicine. 2015;5(1):e23409. https://doi.org/10.5812/aapm.23409
Arslan M, Kurtipek O, Dogan AT, Unal Y, Kizil Y, Nurlu N, Kamaci S, Kavutcu M. Comparison of effects of anaesthesia with desflurane and enflurane on liver function. Singapore Medical Journal. 2009;50(1):73-77.
Konrady AB, Plotkin LL. Influence of the Anesthesiology Assistance on the Liver Functional Condition. Annaly khirurgicheskoj gepatologii. 2011;16(1):99-106. (In Russ.).
Kharasch ED. Biotransformation of sevoflurane. Anesthesia and Analgesia. 1995;81(6):27-38. https://doi.org/10.1097/00000539-199512001-00005
Kneiseler G, Bachmann HS, Bechmann LP, Dechene A, Heyer T, Baba H, Saner F, Jochum C, Gerken G, Canbay A. A rare case of propofol-induced acute liver failure and literature review. Case Reports in Gastroenterology. 2010;4(1):57-65. https://doi.org/10.1159/000262448
Batistaki C, Michalopoulos G, Matsota P, Nomikos T, Kalimeris K, Riga M, Nakou M, Kostopanagiotou G. CYP2E1 immunoglobulin G4 subclass antibodies after desflurane anesthesia. World Journal of Hepatology. 2014;6(5):340-346. https://doi.org/10.4254/wjh.v6.i5.340
Atici S, Doruk N, Sari A, Birbicer H, Bilgin E, Unlu R, Demirkan F, Oral U. Long-duration sevoflurane effects on postoperative hepatic and kidney function. European Journal of Anaesthesiology. 2006;23:160. https://doi.org/10.1097/00003643-200606001-00576
Hussey AJ, Aldridge LM, Paul D, Ray DC, Beckett GJ, Allan LG. Plasma glutathione S-Transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane. British Journal of Anaesthesia. 1988;60(2):130-135. https://doi.org/10.1093/bja/60.2.130
Suttner SW, Schmidt CC, Boldt J, Hüttner I, Kumle B, Piper SN. Low-flow desflurane and sevoflurane anesthesia minimally affect hepatic integrity and function in elderly patients. Anesthesia and Analgesia. 2000;91(1):206-212. https://doi.org/10.1097/00000539-200007000-00039
Mikstacki A, Zakerska-Banaszak O, Skrzypczak-Zielinska M, Tamowicz B, Szlata M, Slomski R. Glutathione S-transferase as a toxicity indicator in general anesthesia: genetics and biochemical function. Journal of Clinical Anesthesia. 2015;27(1):73-79. https://doi.org/10.1016/j.jclinane.2014.07.002
Chikezie PC. Glutathione S-transferase activity in diagnostic pathology. Metabolomics: Open Access Journal. 2015;153(5):1-12. https://doi.org/10.4172/2153-0769.1000153
Ray DC, Bomont R, Mizushima A, Kugimiya T, Forbes Howie A, Beckett GJ. Effect of sevoflurane anaesthesia on plasma concentrations of glutathione S-transferase. British Journal of Anaesthesia. 1996;77(3):404-407. https://doi.org/10.1093/bja/77.3.404
Sahin H, Pirat A, Arslan G. Anaesthesia and surgery in patients with abnormal preoperative liver enzymes. European Journal of Anaesthesiology. 2007;24(5):465-467. https://doi.org/10.1017/S0265021506002079