Comparison of the antioxidant effects of isoflurane and propofol in patients undergoing right donor hepatectomy

Background and aim: There has been an increase in the number of living donor liver transplantations due to an increasing need for donor organs related to increasing patient population and lack of cadaveric organ donation in our country. Both the surgical stress and ischemia after pringle maneuver during donor hepatectomy may induce oxidative stress. Therefore, in donor hepatectomy surgery, the antioxidative effects of anesthetic agents may be clinically important.The aim of this study was to find out the effects of isoflurane and propofol on oxidant and antioxidant system at living donor liver transplantations.Materials and Methods: A total of 70 patients ASA I-II between the ages of 18-65, to whom right hepatectomy planned were divided into two groups as propofol group (n = 35) and isoflurane group (n = 35). To the patients in propofol group, propofol, remifentanil and O2/air was administered, while to the patients in isoflurane group, anesthesia was administered using isoflurane, remifentanil O2/air. Throughout the operation, the patients systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, SpO2, ETCO2, TOF, and BIS values were recorded every 30 minutes. At the end of the operation, time to extubation, eye opening and recovery were recorded and observed complications were recorded.For all patients, arterial blood samples were collected during preoperative period, at the 1st hour of intraoperative and at the 1st hour of postoperative period. In order to assess the effect of antioxidant, plasma superoxide dismutase (SOD), malondialdehyde (MDA), total oxidative status (TOS), and total antioxidant capacity (TAC) levels were examined. Oxidative stress index (OSI) was calculated.Results: There was no difference between groups in terms of demographic characteristics, anesthesia, surgical times and graft weight, HR, SBP, DBP, MAP, BIS, SpO2, body temperature, urine output, estimated blood loss.There was a statistically significant difference (p <0.05) between propofol and isoflurane groups in terms of eye opening and extubation. This difference is found to be lower in propofol group.In both groups, intraoperative TAC levels decreased compared to preoperative period. Compared to preoperative period postoperatively TAC levels decreased the propofol group, increased the isoflurane group (p <0.05). The amount of this change was statistically significant (p <0.05).In both groups, OSI levels are found to be increased at intraoperative period compared to preoperative period. In the propofol group, the postoperative OSI values are significantly higher (p <0.05) compared to isoflurane group.The level of MDA increased in isoflurane group than in the propofol group intraoperatively (p <0.05). Compared to preoperative period postoperatively MDA levels decreased the propofol group, increased the isoflurane group. The amount of this change was statistically significant (p <0.05).Conclusion: In the present study in which the effects of two different anesthetic techniques in donor hepatectomy operations on oxidative stress, it was seen that propofol considerably lowers MDA which is an indicator of lipid peroxidation. But in the propofol anesthesia, the TAC level showing the total antioxidant activity has lowered. Although propofol show an antioxidant affect in vivo and vitro experimental studies, we are of the opinion that the effectiveness of the blood concentrations requires much more research in clinical applications.