[Clinical experience in using isoflurane, sevoflurane, and total intravenous anesthesia during visceral...

Based on 256 anesthesias, the authors comparatively studied the results of total intravenous anesthesia (TIVA) with neuroleptic analgesics and inhalational low- and minimal flow anesthesia with isoflurane in the anesthestic support of major operations on the liver. Both sevoflurane and isoflurane may be widely used during long and traumatic operations on the liver since the agents are distinguished by a low hepatotoxicity, the absence of pharmacological activity of their metabolism, a rapid elimination from the body in a virtually unchanged form. The use of sevoflurane and isoflurane in the low and minimal flow modes can substantially reduce the pharmacological load with opiates and myorelaxants, which is particularly important in patients with liver diseases and these modes have some advantage over TIVA during which the consumption of myorelaxants and neuroleptic analgesics has proved to be significantly higher. The minimal flow (0.4-0.5 l/min) mode uses mostly few inhalation anesthetics. The use of seroflurane reduces the period of spontaneous breathing recovery to a greater extent, activates the patient more rapidly, and substantially reduces the risk of iatrogenic complications after long and traumatic operations associated with visceral transplantation.