Anesth Pain Med.  2019 Jul;14(3):272-279. 10.17085/apm.2019.14.3.272.

The comparison of desflurane and sevoflurane on postoperative hepatic function of infant with biliary atresia undergoing Kasai operation

• Lee J
• Kim MS
• Lee HM
• Lee JR
• Park JH

• KMID: 2454811
• DOI: http://doi.org/10.17085/apm.2019.14.3.272

Abstract

BACKGROUND
Biliary atresia is an extrahepatic progressive obliterate cholangiopathy that occurs in infants. Kasai procedure, a surgical method that can help re-establish bile flow from the liver into the intestine, is its first line treatment. Since infants with biliary atresia already have advanced hepatic dysfunction, all kinds of schemes should be considered to minimize further liver damage during surgery. The objective of this study was to compare the postoperative hepatic functions between the two commonly used inhalational anesthetics in infants undergoing the Kasai procedure (i.e., desflurane and sevoflurane).
METHODS
This prospective, randomized, double-blind, single-center, and parallel group study included 40 children undergoing Kasai procedure. They were randomly allocated to Group S (sevoflurane) or Group D (desflurane). All the patients were anesthetized with designated anesthetic agent with the end-tidal concentration of about 0.8-1 minimum alveolar concentration. Postoperative hepatic functions were assessed by aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, prothrombin time, and total bilirubin.
RESULTS
A total of 38 patients were selected for the study. In both groups, AST, ALT were increased in magnitude to the peak on postoperative day 0 and decreased to preoperative value at postoperative day 3. There were no significant differences between the groups in any laboratory results related to liver function.
CONCLUSIONS
Sevoflurane and desflurane, inhalation anesthetics for maintaining anesthesia used in infants undergoing the Kasai procedure, did not show any difference in preserving postoperative hepatic function.

Keyword

Desflurane; Infant; Liver function tests; Portoenterostomy, hepatic; Sevoflurane

MeSH Terms

Alanine Transaminase
Anesthesia
Anesthetics
Anesthetics, Inhalation
Aspartate Aminotransferases
Bile
Biliary Atresia*
Bilirubin
Child
Humans
Infant*
Intestines
Liver
Liver Function Tests
Methods
Portoenterostomy, Hepatic
Prospective Studies
Prothrombin Time
Alanine Transaminase
Anesthetics
Anesthetics, Inhalation
Aspartate Aminotransferases
Bilirubin

Figure

• 

  Fig. 1 Consolidated Standards of Reporting Trials flow diagram. Group S: sevoflurane, Group D: desflurane.

• 

  Fig. 2 Fig. 2. Changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), albumin, prothrombin time (PT) (international normalized ratio, INR), and total bilirubin. AST and ALT increase immediately in magnitude to the peak after surgery in both groups and decrease gradually, showing a similar value at 3 days postoperatively, but there is no significant difference between the two groups. Values are expressed as mean ± SD. POD: postoperative days, pre: preoperative period, op: operation day.

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