Cerebral protective effect of nicorandil premedication on patients undergoing liver transplantation

作者：Xia, Yun Fei; Wang, Zheng Ping^*; Thou, Ya Chun; Yan, Tao; Li, Shi Tong

来源：Hepatobiliary and Pancreatic Diseases International, 2012, 11(2): 132-136.

DOI：10.1016/S1499-3872(12)60137-4

• nicorandil
• premedication
• liver transplantation
• cerebral protection

BACKGROUND: Neurological injury is a common complication in the early period after liver transplantation, posing an enormous obstacle to treatment efficiency and patient survival. Nicorandil is a mitochondrial ATP-sensitive potassium channel (mitoK(ATP),) opener. It has been reported to be effective in reducing brain injury in recent studies. However, it is still unclear whether nicorandil has cerebral protective effect in patients undergoing liver transplantation.
METHODS: Fifty patients scheduled for liver transplantation were randomly divided into a nicorandil group (group N) (n=25), in which patients received 10 mg nicorandil through a nasogastric tube 30 minutes before induction of anesthesia, and a control group (group C) (n=25) who received 10 mL normal saline. The Mini-Mental State Examination (MMSE) was performed before anesthesia (day 0), and on days 3 and 7 after surgery. Blood samples were obtained before induction of anesthesia (T1), and at 12 (T2) and 36 hours (T3) after surgery for determination of serum neuron-specific enolase (NSE) and S100 beta protein (S100 beta) concentrations.
RESULTS: During surgery, 5 patients in each group were eliminated due to severe reperfusion or renal insufficiency. Therefore, 20 patients remained in each group. The MMSE scores after operation were significantly lower than those before operation in group C. However, there was no difference at days 3 and 7 compared with day 0 in group N. Serum NSE concentrations after surgery were significantly higher than baseline (at T1) in both groups, except at T3 in group N. Serum S100 beta concentration after surgery was significantly higher than baseline (at T1) in both groups. The MMSE scores at days 3 and 7 in group N were significantly higher than those in group C. The concentrations of serum NSE and sloop at T2 and T3 in group N were significantly lower than those in group C.
CONCLUSIONS: Oral nicorandil, as a premedication before liver transplantation, improves postoperative MMSE scores. It also attenuates the increase of NSE and sloop in blood, indicating its cerebral protective effect.

• 出版日期2012-4
• 单位上海交通大学