الفهرس 
Hepatocellular CarcinomaOnly 14 pages are availabe for public view
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Abstract
Different Anesthetic Techniques for Radiofrequency Ablation of Hepatocellular Carcinoma
Amir Ibrahim Salah MD, Ahmed K. El Dorry MD, Hanan M. Farag MD, Dalia A. El Hamid Mohamed MD, Mostafa G. Mahran MD, Marwa A. Khairy MSc.
Abstract
Background: Hepatocellular carcinoma (HCC) is a significant worldwide health problem. Radiofrequency ablation has emerged as an effective method for local tumor destruction .Anesthetic techniques for liver patients still have many controversial issues for anesthesiologists who want to provide optimal care for their patients. The primary outcome of this study is to evaluate the effects of sevoflurane and propofol as regards induction, maintenance and recovery criteria in patients undergoing radiofrequency ablation for hepatocellular carcinoma , the secondry outcome is to identify complications associated with the anesthetic technique that will be used..
Patients and methods : This randomized prospective double blinded controlled clinical trial was done in Ain Shams University hospitals on 120 patients of both sexes scheduled for radiofrequency ablation of hepatocellular carcinoma. They were divided into 3 equal groups; 40 patients each: Group (PI) induction with propofol and maintenance with isoflurane, Group (PP) Induction and maintenance of anesthesia with propofol Group (SS) induction and maintenance of anesthesia with sevoflurane. Induction, maintenance and recovery criteria include( Induction time, intubation time, spontaneous eye opening time, extubation time and orientation time). Mean arterial pressure (MAP) and heart rate (HR) were recorded at different times along the procedure; adverse effects during induction and recovery were recorded. Follow up alanine aminotransferase (ALT) and aspartate aminotransferase (AST) tests were done 2 hours postoperatively and recorded. Cost-effectiveness was also noted.
Results:
The study revealed that propofol has the least induction time, less post operative nausea and vomiting. This study also showed a decrease in the MAP following induction in all groups but more significant in the propofol groups compared with the sevoflurane group. While HR was lower in the sevoflurane maintenance group compared with the propofol maintenance group. Sevoflurane has slightly better recovery time than propofol in liver patients. Sevoflurane and propofol maintenance groups showed similar levels of elevated liver enzymes. Cost of sevoflurane induction and maintenance was similar to propofol induction and maintenance.
Conclusion: the anesthetic management using inhalational agents (isoflurane or sevoflurane) in combination with small doses of IV induction agents (propofol) can be considered as the anesthetic management of choice provided that adequate pulmonary ventilation and arterial pressure are maintained.