Effects of sevoflurane and isoflurane anesthesia on arterial ketone body ratio and liver function

Background: The purpose of this study was to compare the effect on arterial ketone body ratio (AKBR), which indicates hepatic mitochondrial energy cha rge in relation to hepatic blood flow and liver function test (serum levels of liver enzymes) between sevoflurane and isoflurane anesthesia. Methods: Serum levels of aspartate aminotransferase (AST), alanine aminotra nsferase (ALT), total bilirubin (TBil), alkaline phosphatase (ALP), gamma-g lutamyl transpeptidase (GTP), and lactate dehydrogenase (LDH) were measured before and 1, 2, 3, 7, and 14 days after anesthesia in each of 60 patients receiving either sevoflurane or isoflurane anesthesia for neurosurgery (tu mor resection). In 13 patients of both groups, arterial concentrations of a cetoacetate and S-hydroxybutyrate were also measured before, during and aft er (up to 12 h) anesthesia and the AKBR was calculated. Results: AST, ALT and GTP increased, peaking 7 days after anesthesia, espec ially in the isoflurane group. There was a significantly greater number of patients with abnormal AST and ALT values in the isoflurane group than in t he sevoflurane group. The increase of TBil had its peak 1 day after anesthe sia in both groups. AKBR decreased after anesthesia induction and recovered to the control value 12 h after anesthesia in both groups. There was no di fference between the two anesthetic groups in AKBR. Conclusion: Isoflurane induced an elevation of serum levels of liver enzyme s more frequently than did sevoflurane 3 to 14 days after anesthesia, while AKBR until 12 h after anesthesia did not show any significant difference b etween sevoflurane and isoflurane anesthesia.