Noninvasive ICG clearance test for estimating hepatic blood flow during halothane and isoflurane anaesthesia

The purpose of this study was to estimate hepatic blood flow during halothane (HAL) or isoflurane (ISO) anaesthesia with the noninvasive indocyanine green (ICG) clearance test. Twenty-four ASA status I adult patients, scheduled for elective surgery without liver disease, were allocated into four groups. Before surgery, ICG clearance was measured twice in patients before and after 1, 2 MAC HAL-N2O, 1 and 2 MAC ISO-N2O anaesthesia by ICG clearance meter (Sumitomo Electron-ics™, Japan). This method eliminates the blood sampling and delay of the conventional ICG test. The ICG clearance is displayed in two indices: K (ICG disappearance rate) and R15 (ICG retention rate 15 min after 0.5 mg · kg−1 ICG injection). Indirect blood pressure and heart rate were measured simultaneously. Mean arterial pressure (MAP) decreased by 27, 22 and 29% with 2 MAC HAL-N2O, and with 1 and 2 MAC ISO-N2O groups, respectively (P < 0.05). The ICG clearance was less (P < 0.05) in the 2 MAC HAL-N2O group (K, 0.087 min−1) than with either awake (K, 0.131 min−1) or other groups (K, 0.114 and 0.144 min−1, in the 1 MAC HAL and ISO-N2O groups, respectively) in spite of a similar degree of the depletion of MAP in 2 MAC ISO-N2O group (K, 0.124 min−1). We conclude that isoflurane has a more favourable effect on liver circulation than does halothane.RésuméCe travail vise à évaluer le débit sanguin hépatique pendant l’anesthésie à l’halothane (HAL) ou à l’isoflurane (ISO) par l’épreuve de clairance non invasif du vert d’indocyanine (ICG). Vingt-quatre adultes ASA I exempts de toute affection hépatique, programmés pour une chirurgie non urgente sont répartis en quatre groupes. Avant l’intervention, la clairance de l’ICG est mesurée à deux reprises avant et après une anesthésie HAL-N2O MAC 1 et 2, et ISO-N2O MAC 1 et 2, avec un appareil de mesure d’ICG (Sumitomo Electronics™, Japon). Cette méthode élimine l’échantillonnage sanguin et le délai propre à l’épreuve d’ICG conventionnelle. La clairance de l’ICG est affichée sous deux index: K (la vitesse de disparition de l’ICG) et R15 (le taux de rétention de l’ICG 15 min après l’injection de 0,5 mg · kg−1 d’ICG). La pression artérielle indirecte et la fréquence cardiaque sont mesurées simultanément. La pression artérielle moyenne (PAM) diminue de 27, 22 et 29% respectivement dans le groupe HAL-N2O MAC 2, et dans les groupes ISO-N2O MAC 1 et 2 (P < 0,05). La clairance de l’ICG est moins élevée (P < 0,05) dans le groupe HAL-N2O MAC 2 (K, 0,087 min−1) que soit dans les groupes éveillés (K, 0,131 min−1) ou les autres groupes (K, 0,114 et 0,144 min−1, respectivement, dans les groupes HAL-N2O MAC 1 et ISO-N2O) malgré un niveau de diminution de la PAM identique dans le groupe ISO-N2O MAC 2 (K, 0,124 min−1). Nous concluons que l’isoflurane a un effet plus favorable sur la circulation hépatique que l’halothane.

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