Maintaining hepato-splanchnic blood flow and perfusion pressure is important for survival of organs. Both propofol and sevoflurane, have an effect on hepato-splanchnic blood flow. Animal studies suggest that sevoflurane results in a reduction of portal blood flow and an increase hepatic arterial blood flow1. Propofol increases total hepato-splanchnic blood flow, primarily by an increased portal blood flow2. The aim of this study was to evaluate and compare the effect of sevoflurane versus propofol on hepatic blood flow during hepatobiliary surgery.
Methods: After ethical committee approval and written informed consent, 22 patients undergoing pancreaticoduodenectomy were randomized to receive either propofol TCI (Schnider model) (P group) or sevoflurane (S group). All patients received individualized goal-directed hemodynamic therapy. Hemodynamic variables were recorded at designated times using the PiCCO system (Pulsion Medical System). Hepatic blood flow was measured by the surgeon using ultrasound transit time flow measurements (Medi-Stim AS). Hemodynamic measurements were recorded, compared and related to hepatic blood flow measurements. After testing for normal distribution, data between groups were compared using a two-way ANOVA for repeated measurements.
Results: A total of 15 patients were included. There was no significant difference in cardiac index. The S group has significant lower MAP (P = 0.03) and higher need for vasopressor support (P < 0.01). There was no significant difference between both groups in total hepatic blood flow. Relative blood flow in the hepatic artery and portal vein show similar results.
Conclusion: With similar CI, we found no statistically significant difference in hepatic blood flow between both groups. The need for vasopressor support was significantly higher in the S group compared to the P group. Further research is needed to understand the mechanism and clinical impact of these findings.
References:
1. Bernard JM, et al. Anesthesiology. 1992;77(3):541-545.
2. Meierhenrich R, et al. Anaesthesia. 2010;65(11):1085-1093.

05 / Effect of propofol and sevoflurane on hepato - splanchnic blood flow: preliminary