Evaluation of changes in liver enzymes by administration of three drug regimens: propofol, isoflurane and propofol -isoflurane as anesthesia maintenance in patients with elective rhinoplasty

This study was designed to evaluate changes in liver enzymes, biochemical markers of hepatocyte function, when anesthesia is maintained with three drug regimens: propofol, isoflurane and co-administration of propofal –isoflurane. One hundred and twenty patients aged 18 to 35, ASA class I risk groups, scheduled for elective rhinoplasty were randomly allocated into three equal groups of 40. Venous blood samples of the patients were obtained before induction of anesthesia and 4 hours after recovery from anesthesia in order to evaluate pre and post operation liver enzyme values. In all 3 groups general anesthesia was induced with propofol 2mg/kg, midazolam 0.03mg/kg and fentanyl 1.5 mcg/kg. In the propofol group anesthesia was maintained with propofol infusion 150mcg/kg/min. In the isoflurane group inhalatory isoflurane 1.2 MAC (minimal alveolar concentration) was used and in the propofol-isoflurane group, patients received propofol infusion 75mcg/kg/ minute and isoflurane 0.6 MAC as maintenance of anesthesia. In all threegroups remifentanil infusion 0.15mcg /kg/min was used for induced hypotension (MAP=55-65). Findings demonstrated that post anesthesia aspartate aminotransferase (AST) alanine aminotransferase (ALT) and alkaline phosphatase (ALP) values significantly decreased in all groups. These differences were statistically significant. It is suggestive that the co- administration of isoflurane-propofol as anesthesia maintenance along with remifentanil infusion not only does not increase ALT, AST and ALP levels but can also cause a decrease in enzyme levels. Therefore this regimen can be used for maintenance of anesthesia especially in operations in which induced hypotension is needed.