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

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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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