الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Liver cirrhosis is a well-established host factor for the development of Hepatocellular carcinoma (H.C.C.) as 80% of autopsied HCC patients had cirrhosis. Hepatectomy in cirrhotic patients is difficult because those patients have unsatisfactory liver function reserve, bleeding tendency and are hypermetabolic, malnourished and immunocompromised. This study was carried to evaluate the possible peri-anesthetic biochemical, hemodynamic and blood gasometric changes in patients submitted for surgical resection of hepatic tumors under different anesthetic techniques. This randomized prospective study was conducted on 36 patients of either sex with age ranging between 20 - 60 years, randomly allocated into 3 equal groups - each of twelve - according to the used anesthetic agent to receive either isoflurane (group I), sevoflurane (group II ) or propofol (group III ) . All the patients were premedicated by atropine (0.01mg.kg-1) and fentanyl (1ug.kg-1) I.V. Also, lumber epidural catheterization at level L2-3. was performed using Touhy needle and mixture of bupivacaine 0.25% (0.8mg/kg) & morphine(30ug/kg) was injected. All patients were monitored peri-operatively for biochemical, hemodynamic and blood gasometric parameters. The results of the study showed that, the liver function tests were all deteriorating in the first three post operative days & began to improve on seventh postoperative day. The rate of improvement was faster in propofol group evidenced by the significant decrease in serum bilirubin compared with sevoflurane group and also the significant decrease in liver enzymes compared with both isoflurane & sevoflurane groups. Blood sugar showed a highly significant increase in the 3 groups compared with the basal values on the first & second postoperative days with a significant decrease in the postoperative hyperglycemia in propofol group compared with isoflurane and sevoflurane groups. From the pervious Study it can be concluded that, there was no significant difference in between the three anesthetic groups despite of the significant decrease in the liver enzymes, serum bilirubin and blood sugar in propofol group compared with isoflurane or sevoflurane groups. Yet, these changes were only significant statistically. Clinically, they are within the normal clinical range. Direct traumatic effect of the surgical procedures on the liver is the main factor responsible for the significant peri-anesthetic, biochemical, hemodynamic and blood gasometric changes in patients submitted for surgical resection of hepatic tumors. Finally, both techniques either inhalational (with isoflurane or sevoflurane) or TIVA (with propofol) can be used safely in hepatic surgery with superiority of propofol as an induction and maintenance agent as regards less elevations of postoperative liver enzymes, serum bilirubin & blood sugar. It remains uncertain whether the choice of anesthetic agents or techniques, if applied appropriately, alters the outcome of the patient.