# Impact of different anesthetics on ischemia reperfusion injuries in patients undergoing hepatectomy: a network meta-analysis

## TL;DR

This study compares different anesthetics to see which ones best protect the liver during surgery by reducing enzyme levels linked to injury.

## Contribution

The novel contribution is identifying the propofol and sevoflurane combination as most effective for reducing liver enzyme elevations during hepatectomy.

## Key findings

- The combination of propofol and sevoflurane showed highest effectiveness in reducing AST and ALT levels.
- Propofol monotherapy and other combinations ranked lower in enzyme reduction effectiveness.
- The findings suggest this anesthetic combination could help protect liver function post-surgery.

## Abstract

Hepatectomy, a commonly employed surgical approach for treating liver-related disorders, has emerged as the primary method for the radical treatment of early stage liver cancer. This network meta-analysis was conducted to evaluate the impacts of different anesthetics on ischemia reperfusion injuries in patients undergoing hepatectomy.

Randomized controlled trials (RCTs) and cohort studies were identified through searches in four databases, PubMed, Embase, the Cochrane Library, and the Web of Science, up to February 12, 2025. Non-English studies were excluded, and this study was conducted in compliance with PRISMA-NMA guidelines. Bayesian network meta-analysis was employed based on the R 4.3.2 and Stata 15.1. The efficacy of each intervention was evaluated through SUCRA (surface under the cumulative ranking curve).

The analysis included 19 studies with a total of 1,319 participants. In terms of reducing aspartate transaminase (AST) levels, the combination of propofol and sevoflurane exhibited the highest effectiveness (SUCRAs: 71.82%), followed by the combination of propofol, isoflurane, and fentanyl (SUCRAs: 61.87%), and sevoflurane monotherapy (SUCRAs: 58.61%). The combination of propofol and sevoflurane (SUCRAs: 71.94%) ranked first for reducing ALT levels, followed by propofol monotherapy (SUCRAs: 61.71%) and the combination of propofol and sufentanil (SUCRAs: 58.59%).

The combination of propofol and sevoflurane appear to be the most effective approach for reducing AST and ALT levels. This combination could serve as a favorable anesthetic strategy to limit hepatic enzyme elevations after hepatectomy, thus supporting liver function protection.

https://www.crd.york.ac.uk/PROSPERO/home, identifier CRD42023472070.