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Anesthetic Methods and Liver Transplantation

This study is currently recruiting participants. (see Contacts and Locations)
Verified September 2013 by National Taiwan University Hospital
Sponsor:
Information provided by (Responsible Party):
National Taiwan University Hospital
ClinicalTrials.gov Identifier:
NCT01936545
First received: August 27, 2013
Last updated: September 3, 2013
Last verified: September 2013

August 27, 2013
September 3, 2013
May 2011
July 2014   (final data collection date for primary outcome measure)
Change of cardiac output perioperatively [ Time Frame: one week ] [ Designated as safety issue: No ]
Cardiac output(l/min) was measured by thermodilution method perioperatively.
Same as current
Complete list of historical versions of study NCT01936545 on ClinicalTrials.gov Archive Site
lung injury score [ Time Frame: one week ] [ Designated as safety issue: No ]
PaO2/FiO2(Arterial oxygen tension/fraction of inspired oxygen)
Same as current
Reactive oxygen species [ Time Frame: one week ] [ Designated as safety issue: No ]
Reactive oxygen species measured by chemiluminescence method
Same as current
 
Anesthetic Methods and Liver Transplantation
The Impact of Different Anesthetic Methods on Ischemia Reperfusion Injury Following Liver Transplantation

Postoperative pulmonary complications are not uncommon after liver transplantation. They can not only prolong the stay in intensive care unit and in hospital but also increase the morbidity and mortality rate. The underlying mechanisms are multifactorial, however, oxidative stress following hepatic ischemia reperfusion and the ensuing pulmonary leukocyte infiltration play an important part in the pulmonary complications. Various drugs and methods such as ischemic preconditioning have been used to lessen the production of oxidative free radicals following hepatic ischemia reperfusion. The choice of different anesthetic agents could aslo change the degree of production of oxygen species and antioxidant capacity during the operation.

Volatile and intravenous anesthetic agents can decrease oxidative injuries through different mechanisms, however, which is better in preventing the pulmonary leukocyte infiltration is still unknown.

We attempt the compare the oxidative stress and cytokine level in liver transplant recipients under desflurane or propofol anesthesia to evaluate which kind of anesthetic agent is better in this kind of surgery.

The occurrence of postoperative pulmonary complications after hepatic reperfusion, such as in patients undergoing liver transplantation, is a major concern in the intensive care unit. Not only neutrophil infiltration, but also oxidative injuries, have been demonstrated after intra-operative hepatic ischemia/reperfusion (I/R) management. Previous studies have shown that reactive oxygen species (ROS) paly a major role in the ensuing damage, although I/R-induced remote organ injury is a complex and multifactorial process. Methods to reduce ROS generation, such as ischemic preconditioning, attenuate both liver and lung damage after hepatic I/R. Considering the intra-operative ROS production occurs after hepatic reperfusion , the choice of anesthetics may alter the magnitude of ROS production and the antioxidant capacity.

Volatile and non-volatile anesthetics can exert their antioxidant capacity through different mechanisms. Propofol (2,6-diisopropylphenol) has been reported to provide antioxidant capacity by scavenging free radicals. However, volatile anesthetics such as isoflurane, desflurane or sevoflurane can reduce the oxidative damage through anesthetic preconditioning. Several animal studies demonstrate that volatile anesthetics offer more protection against ischemia-reperfusion injury than intravenous anesthetics. On the contrary, intravenous anesthetics may be more protective against sepsis-induced hepatic injury than volatile anesthetics. However, there are few investigations concerning the effects of different anesthetics on remote pulmonary injuries in clinical settings.

In this study, propofol and desflurane will be used for the maintenance of anesthesia during liver transplantation. The heart function, respiratory function, liver function, kidney function, the oxidative injuries and inflammatory mediators will be compared between the two groups.

Interventional
Not Provided
Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Subject)
Primary Purpose: Prevention
Acute Lung Injury
  • Drug: propofol during liver transplantation.
    The anesthesia was maintained with propofol during liver transplantation.
    Other Name: propofol
  • Drug: Desflurane during liver transplantation.
    The anesthesia was maintained with desflurane during liver transplantation.
    Other Name: Desflurane
  • Experimental: propofol
    The anesthesia was maintained with propofol during liver transplantation.
    Intervention: Drug: propofol during liver transplantation.
  • Active Comparator: Desflurane
    The anesthesia was maintained with desflurane during liver transplantation.
    Intervention: Drug: Desflurane during liver transplantation.
Aduen JF, Stapelfeldt WH, Johnson MM, Jolles HI, Grinton SF, Divertie GD, Burger CD. Clinical relevance of time of onset, duration, and type of pulmonary edema after liver transplantation. Liver Transpl. 2003 Jul;9(7):764-71.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
50
July 2014
July 2014   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • End stage liver disease scheduled for liver transplantation in National Taiwan University Hospital

Exclusion Criteria:

  • Pre-existing pulmonary disease
  • coma
Both
18 Years to 75 Years
No
Contact: Kuang Cheng Chan, M.D. 886-2-23123456 ext 62158 jkjchan@gmail.com
Taiwan
 
NCT01936545
201003116M
No
National Taiwan University Hospital
National Taiwan University Hospital
Not Provided
Principal Investigator: Kuang Cheng Chan, M.D. Department of Anesthesiology, NTUH, Taipei, Taiwan
National Taiwan University Hospital
September 2013

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP