Yonsei Med J.  2013 Jan;54(1):231-237. 10.3349/ymj.2013.54.1.231.

The Influence of the Severity of Chronic Virus-Related Liver Disease on Propofol Requirements during Propofol-Remifentanil Anesthesia

• Wu J
• Huang SQ
• Chen QL
• Zheng SS

• KMID: 1776944
• DOI: http://doi.org/10.3349/ymj.2013.54.1.231

Abstract

PURPOSE
The purpose of this study was to investigate the influence of chronic virus-related liver disease severity on propofol requirements.
MATERIALS AND METHODS
In this study, 48 male patients with chronic hepatitis B infection were divided into three groups according to Child-Turcotte-Pugh classification of liver function (groups A, B, and C with mild, moderate and severe liver disease, respectively). After intubation, propofol concentration was adjusted by +/-0.3 microg/mL increments to maintain bispectral index in the range of 40-60. Target propofol concentrations at anesthesia initiation, pre-intubation and pre-incision were recorded.
RESULTS
The initial concentration used in group C was significantly lower than that used in group A or B (p<0.05), whereas no difference was observed between groups A and B. At pre-intubation, the actual required concentration of propofol increased significantly (3.2 microg/mL) in group A (p<0.05), which lead to significant differences between the groups (p<0.05). At pre-incision, the requirements for propofol decreased significantly in both groups A and B (3.0 microg/mL and 2.7 microg/mL, respectively) compared with those at pre-intubation (p<0.05), and were significantly different for all three groups (p<0.05), with group C demonstrating the lowest requirement (2.2 microg/mL). The required concentrations of propofol at pre-incision were similar to those at induction.
CONCLUSION
In this study, propofol requirements administered by target-controlled infusion to maintain similar depths of hypnosis were shown to depend on the severity of chronic virus-related liver dysfunction. In other words, patients with the most severe liver dysfunction required the least amount of propofol.

Keyword

Propofol; liver disease; electroencephalography

MeSH Terms

Adult
Anesthesia
Anesthetics, Intravenous/*administration & dosage
Chronic Disease
Electroencephalography
Hepatitis B, Chronic/complications/drug therapy/*surgery
Humans
Liver Diseases/*complications/surgery
Male
Middle Aged
Piperidines/*administration & dosage
Propofol/*administration & dosage
Virus Diseases/*complications/surgery
Anesthetics, Intravenous
Piperidines
Propofol