Comparison of target concentration of propofol during three phases of live donor liver transplant surgery using a target-controlled infusion of propofol total intravenous anaesthesia - A prospective, observational pilot study

Neha Garg; Yatin Kalra; Shivali Panwar; Mahesh K Arora; Udit Dhingra

doi:10.4103/ija.ija_535_24

Comparison of target concentration of propofol during three phases of live donor liver transplant surgery using a target-controlled infusion of propofol total intravenous anaesthesia - A prospective, observational pilot study

Indian J Anaesth. 2024 Nov;68(11):971-977. doi: 10.4103/ija.ija_535_24. Epub 2024 Oct 26.

Authors

Neha Garg¹, Yatin Kalra², Shivali Panwar², Mahesh K Arora², Udit Dhingra²

Affiliations

¹ Department of Anaesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Delhi, India.
² Department of Anaesthesia, Institute of Liver and Biliary Sciences, Delhi, India.

Abstract

Background and aims: Three phases (dissection, anhepatic, and neohepatic) exist for propofol pharmacokinetics during liver transplantation (LT), resulting in varying cardiac output, volume of distribution, and drug metabolism. The primary objective was to compare the mean target concentration of propofol required to maintain the bispectral index (BIS) between 40 and 60 during three phases of LT by using a target-controlled infusion of total intravenous anaesthesia (TCI-TIVA).

Methods: In this prospective, observational study, 20 adult patients diagnosed with chronic liver disease scheduled for live-donor LT were included. After anaesthesia induction and tracheal intubation, BIS-guided propofol infusion was started using TCI-TIVA with target plasma concentration (TPC) set initially at 2.5 μg/mL in all patients using the Marsh model. The TPC was decreased or increased by 0.2 μg/mL whenever the BIS values were persistently below 40 or above 60 for 15 minutes. Data were analysed using ANOVA and repeated measure ANOVA, followed by a post-hoc test.

Results: The mean TPC was significantly higher during dissection [2.12 (Standard deviation (SD): 0.63 μg/mL)] as compared to anhepatic and neohepatic phases [1.29 (SD: 0.65) μg/mL and 1.35 (SD: 0.54) μg/mL], respectively (P < 0.001). A significant difference was observed between dissection and anhepatic (mean difference: -0.87 (95% confidence interval (CI): -0.98, -0.75) or dissection and neohepatic phase (mean difference: -0.77 (95% CI: -1.02, -0.53). The propofol dose was significantly higher in dissection compared to the anhepatic and neohepatic phases (P < 0.001).

Conclusion: The propofol's mean TPC when using TCI-TIVA decreased in the anhepatic and neohepatic phases to 61% and 63.7% of the dissection phase, respectively.

Keywords: Cardiac output; entropy; haemodynamic; liver cirrhosis; liver transplantation; pharmacokinetics; propofol; target control infusion; target plasma concentration; total intravenous anaesthesia.