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document
Hepatic cytoprotective effect of ischemic and anesthetic preconditioning before liver resection when using intermittent vascular inflow occlusion : a randomized clinical trial . BACKGROUND Ischemic preconditioning ( IPC ) and anesthetic preconditioning ( APC ) have been reported to attenuate ischemia-reperfusion ( IR ) injury after liver resection under continuous inflow occlusion . This study evaluates whether these strategies enhance hepatic protection of remnant liver against IR after liver resection with intermittent clamping ( INT ) . METHODS A total of 106 patients without underlying liver disease and submitted to liver resection using INT were randomized into 3 groups : IPC ( 10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection ) , APC ( sevoflurane administration for 20 minutes before liver transection ) , and INT ( no preconditioning ) . Patients were also stratified according to the extent of the hepatectomy . Cytoprotection was evaluated by comparing hepatocyte and endothelial dysfunction markers , apoptosis , histologic lesions , and postoperative outcome . RESULTS No differences were observed in preoperative chemotherapy and steatosis , total warm ischemia time , operative time , or blood loss . Kinetics of transaminases ( aspartate aminotransferase , P = .137 ; alanine aminotransferase , P = .616 ) , bilirubin ( P = .980 ) , and hyaluronic acid increase ( P = .514 ) revealed no differences . Significant apoptosis was present in 40 % of patients , mild-to-moderate leukocyte infiltration and steatosis in 45 % and 55 % , respectively , and mild sinusoidal congestion in 65 % , with a similar distribution in the 3 groups . When patients were stratified by major versus minor resections , no differences were observed in any of the variables studied . Postoperative clinical outcomes were also similar . CONCLUSION These results suggest that these protocols of IPC and APC used in this study do not provide better cytoprotection from IR when INT is used .
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Intervention_Surgical
ischemic
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Intervention_Surgical
anesthetic preconditioning
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Intervention_Surgical
Ischemic preconditioning ( IPC )
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Intervention_Surgical
anesthetic preconditioning ( APC )
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Intervention_Surgical
intermittent clamping ( INT )
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Intervention_Surgical
IPC ( 10 minutes of inflow occlusion followed by 10 minutes of reperfusion before liver transection )
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Intervention_Surgical
APC ( sevoflurane administration for 20 minutes before liver transection )
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Intervention_Surgical
INT ( no preconditioning )
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Intervention_Surgical
IPC
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Intervention_Surgical
APC
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Intervention_Surgical
INT
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Outcome_Physical
Cytoprotection
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Outcome_Other
comparing hepatocyte and endothelial dysfunction markers , apoptosis , histologic lesions , and postoperative outcome
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Outcome_Physical
preoperative chemotherapy and steatosis , total warm ischemia time , operative time , or blood loss
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Outcome_Physical
Kinetics of transaminases
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Outcome_Physical
bilirubin
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Outcome_Physical
hyaluronic acid
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Outcome_Physical
Significant apoptosis
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Outcome_Physical
mild-to-moderate leukocyte infiltration and steatosis
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Outcome_Physical
mild sinusoidal congestion
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Participant_Condition
liver resection with intermittent clamping ( INT )
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Participant_Sample-size
106 patients
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Participant_Condition
liver disease