{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T20:05:57Z","timestamp":1770321957825,"version":"3.49.0"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T00:00:00Z","timestamp":1770249600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/PROSPERO\/home<\/jats:ext-link>\n                      , identifier CRD42023472070.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1607841","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:22Z","timestamp":1770273862000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of different anesthetics on ischemia reperfusion injuries in patients undergoing hepatectomy: a network meta-analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Shaojuan","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangyuan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zehui","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengbo","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, West China Hospital, Sichuan University","place":["Chengdu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1111\/j.1477-2574.2012.00552.x","article-title":"Risk factors of post-operative recurrence and adequate surgical approach to improve long-term outcomes of hepatocellular carcinoma.","volume":"15","author":"Shindoh","year":"2013","journal-title":"HPB."},{"key":"B2","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1080\/13651820410024067","article-title":"Surgical treatment of hepatocellular carcinoma.","volume":"7","author":"Belghiti","year":"2005","journal-title":"HPB."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1073274817744621","DOI":"10.1177\/1073274817744621","article-title":"Liver resection and surgical strategies for management of primary liver cancer.","volume":"25","author":"Orcutt","year":"2018","journal-title":"Cancer Control."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1756","DOI":"10.1016\/j.ejso.2020.03.219","article-title":"Predictors of post-operative complications after surgical resection of hepatocellular carcinoma and their prognostic effects on outcome and survival: a propensity-score matched and structural equation modelling study.","volume":"46","author":"Kabir","year":"2020","journal-title":"Eur J Surg Oncol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1016\/j.jhep.2016.06.006","article-title":"Liver resection for cancer: new developments in prediction, prevention and management of postresectional liver failure.","volume":"65","author":"van Mierlo","year":"2016","journal-title":"J Hepatol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"533","DOI":"10.4254\/wjh.v13.i5.533","article-title":"Direct, remote and combined ischemic conditioning in liver surgery.","volume":"13","author":"Stankiewicz","year":"2021","journal-title":"World J Hepatol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/j.surg.2014.09.005","article-title":"Hepatic cytoprotective effect of ischemic and anesthetic preconditioning before liver resection when using intermittent vascular inflow occlusion: a randomized clinical trial.","volume":"157","author":"Rodr\u00edguez","year":"2015","journal-title":"Surgery."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1016\/j.surg.2015.10.011","article-title":"A network meta-analysis comparing perioperative outcomes of interventions aiming to decrease ischemia reperfusion injury during elective liver resection.","volume":"159","author":"Simillis","year":"2016","journal-title":"Surgery."},{"key":"B9","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1097\/01.sla.0000256891.45790.4d","article-title":"Heme oxygenase-1 induction by the clinically used anesthetic isoflurane protects rat livers from ischemia\/reperfusion injury.","volume":"245","author":"Schmidt","year":"2007","journal-title":"Ann Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1372","DOI":"10.1016\/j.transproceed.2018.03.001","article-title":"Impact of volatile anesthetic agents on early clinical outcomes in liver transplantation.","volume":"50","author":"Mangus","year":"2018","journal-title":"Transplant Proc."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2964","DOI":"10.1016\/j.transproceed.2020.05.013","article-title":"Ischemic preconditioning protects against hepatic ischemia-reperfusion injury under propofol anesthesia in rats.","volume":"52","author":"Kim","year":"2020","journal-title":"Transplant Proc."},{"key":"B12","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1080\/11101849.2023.2190865","article-title":"Propofol\/dexmedetomidine versus desflaurane effects on post hepatectomy hepatocellular injury.","volume":"39","author":"Saad Ali Lashin","year":"2023","journal-title":"Egypt J Anaesth."},{"key":"B13","doi-asserted-by":"publisher","first-page":"2672","DOI":"10.1080\/02648725.2023.2201521","article-title":"Comparison of effects of different anesthesia methods on immune function and liver function of liver cancer patients after operation.","author":"Feng","year":"2024","journal-title":"Biotechnol Genet Eng Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1016\/j.transproceed.2013.02.056","article-title":"Effects of isoflurane and propofol on hepatic and renal functions and coagulation profile after right hepatectomy in living donors.","volume":"45","author":"Ozgul","year":"2013","journal-title":"Transplant Proc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4103\/jwas.jwas_69_22","article-title":"A Comparison of the effect of isoflurane and propofol on liver enzymes.","volume":"12","author":"Oladimeji","year":"2022","journal-title":"J West Afr Coll Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"6726","DOI":"10.21037\/apm-21-1242","article-title":"A meta-analysis and systematic review of propofol on liver ischemia-reperfusion injury protection during hepatocellular carcinoma anesthesia surgery.","volume":"10","author":"Feng","year":"2021","journal-title":"Ann Palliat Med."},{"key":"B17","doi-asserted-by":"publisher","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s tool for assessing risk of bias in randomised trials.","volume":"343","author":"Higgins","year":"2011","journal-title":"Bmj."},{"key":"B18","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1177\/0272989x12455847","article-title":"Evidence synthesis for decision making 4: inconsistency in networks of evidence based on randomized controlled trials.","volume":"33","author":"Dias","year":"2013","journal-title":"Med Decis Making."},{"key":"B20","doi-asserted-by":"publisher","first-page":"f2914","DOI":"10.1136\/bmj.f2914","article-title":"Demystifying trial networks and network meta-analysis.","volume":"346","author":"Mills","year":"2013","journal-title":"Bmj."},{"key":"B21","doi-asserted-by":"publisher","first-page":"618","DOI":"10.1177\/0272989x13485157","article-title":"Evidence synthesis for decision making 3: heterogeneity\u2013subgroups, meta-regression, bias, and bias-adjustment.","volume":"33","author":"Dias","year":"2013","journal-title":"Med Decis Making."},{"key":"B22","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1007\/978-1-62703-059-5_25","article-title":"Bayesian inference.","volume":"930","author":"Bois","year":"2013","journal-title":"Methods Mol Biol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1093\/ije\/dyt043","article-title":"Markov chain Monte Carlo: an introduction for epidemiologists.","volume":"42","author":"Hamra","year":"2013","journal-title":"Int J Epidemiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e76654","DOI":"10.1371\/journal.pone.0076654","article-title":"Graphical tools for network meta-analysis in STATA.","volume":"8","author":"Chaimani","year":"2013","journal-title":"PLoS One."},{"key":"B25","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1186\/s12936-017-1963-0","article-title":"Comparison of anti-malarial drugs efficacy in the treatment of uncomplicated malaria in African children and adults using network meta-analysis.","volume":"16","author":"Whegang Youdom","year":"2017","journal-title":"Malar J."},{"key":"B26","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12874-015-0060-8","article-title":"Ranking treatments in frequentist network meta-analysis works without resampling methods.","volume":"15","author":"R\u00fccker","year":"2015","journal-title":"BMC Med Res Methodol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"666","DOI":"10.7326\/m15-2521","article-title":"Uncertainty in treatment rankings: reanalysis of network meta-analyses of randomized trials.","volume":"164","author":"Trinquart","year":"2016","journal-title":"Ann Intern Med."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1111\/j.1365-2044.2010.06505.x","article-title":"The effect of isoflurane or propofol anaesthesia on liver injury after partial hepatectomy in cirrhotic patients.","volume":"65","author":"Yang","year":"2010","journal-title":"Anaesthesia."},{"key":"B29","doi-asserted-by":"publisher","first-page":"605","DOI":"10.3971\/j.issn.1000-8578.1341","article-title":"comparison of the effects of two different anesthetic techniques on liver function in patients undergoing liver cancer.","volume":"33","author":"Ya-Jun","year":"2006","journal-title":"Cancer Res Prev Treat."},{"key":"B30","first-page":"641","article-title":"Effects of sevoflurane and isoflurane inhalation on ischemia-reperfusion injury in patients with liver cirrhosis.","volume":"31","author":"Shen","year":"2015","journal-title":"J Clin Anesthestol."},{"key":"B31","first-page":"743","article-title":"Living donor hepatectomy (LDH)\u2013comparative study between two different anesthetic techniques.","volume":"18","author":"Rabie","year":"2006","journal-title":"Middle East J Anaesthesiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1213\/01.Ane.0000104581.22295.Fb","article-title":"A comparison of liver function after hepatectomy in cirrhotic patients between sevoflurane and isoflurane in anesthesia with nitrous oxide and epidural block.","volume":"98","author":"Nishiyama","year":"2004","journal-title":"Anesth Analg."},{"key":"B33","first-page":"1055","article-title":"Effects of sevoflurane pretreatment on hepatic ischemia-reperfusion injury during hepatic hydatid surgery at high altitude.","volume":"35","author":"Lyu","year":"2019","journal-title":"J Clin Anesthestol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"872","DOI":"10.3892\/ol.2017.6247","article-title":"Effects of remifentanil on hemodynamics, liver function and ICAM-1 expression in liver cancer patients undergoing surgery.","volume":"14","author":"Jiang","year":"2017","journal-title":"Oncol Lett."},{"key":"B35","first-page":"817","article-title":"Effect of propofol on hepatic ischemia-reperfusion injury.","volume":"28","author":"Hongzhen","year":"2008","journal-title":"Chinese J Anesthesiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1097\/SLA.0b013e31818f3dda","article-title":"A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic.","volume":"248","author":"Beck-Schimmer","year":"2008","journal-title":"Ann Surg."},{"key":"B37","first-page":"659","article-title":"The different effect of isoflurane and propofol-remifentanil on liver function in patients undergoing partial hepatectomy.","volume":"37","author":"Baozhu","year":"2009","journal-title":"Tianjin Med J."},{"key":"B38","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1097\/SLA.0b013e318272df7c","article-title":"Protection of pharmacological postconditioning in liver surgery: results of a prospective randomized controlled trial.","volume":"256","author":"Beck-Schimmer","year":"2012","journal-title":"Ann Surg."},{"key":"B39","doi-asserted-by":"publisher","first-page":"e0290327","DOI":"10.1371\/journal.pone.0290327","article-title":"Protective effect of propofol compared with sevoflurane on liver function after hepatectomy with Pringle maneuver: a randomized clinical trial.","volume":"18","author":"Matsumi","year":"2023","journal-title":"PLoS One."},{"key":"B40","doi-asserted-by":"publisher","first-page":"3694","DOI":"10.3892\/etm.2019.7367","article-title":"Effects of propofol combined with remifentanil anesthesia on the NO, endothelin and inflammatory cytokines in the plasma of patients with liver cirrhosis during the perioperative period.","volume":"17","author":"Wang","year":"2019","journal-title":"Exp Ther Med."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1016\/j.hpb.2019.01.009","article-title":"Effect of pharmacological preconditioning with sevoflurane during hepatectomy with intermittent portal triad clamping.","volume":"21","author":"Nguyen","year":"2019","journal-title":"HPB"},{"key":"B42","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1111\/j.1477-2574.2012.00570.x","article-title":"Does pharmacological conditioning with the volatile anaesthetic sevoflurane offer protection in liver surgery?","volume":"14","author":"Slankamenac","year":"2012","journal-title":"HPB."},{"key":"B43","first-page":"3","article-title":"Influence of the choice of volatile anesthetics on liver enzymes after surgical liver resections.","volume":"39","author":"Petrov","year":"2012","journal-title":"Acta Medica Bulgarica."},{"key":"B44","first-page":"3907","article-title":"Sufentanil and remifentanil combined with dezocine anesthesia for radical resection of liver cancer and its effect on liver and kidney function.","volume":"13","author":"Liao","year":"2020","journal-title":"Int J Clin Exp Med."},{"key":"B45","doi-asserted-by":"publisher","first-page":"921","DOI":"10.3892\/etm.2021.10353","article-title":"Application of propofol combined with sevoflurane anesthesia in staged hepatectomy liver detachment and portal vein ligation.","volume":"22","author":"Xu","year":"2021","journal-title":"Exp Ther Med."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.12089\/jca.2018.12.016","article-title":"Effect of dexmedetomidine for patients undergoing precisehepatectomy in anesthesia intensive care unit.","volume":"34","author":"Jiang","year":"2018","journal-title":"J Clin Anesthestol."},{"key":"B47","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1097\/00000542-200308000-00016","article-title":"Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil-propofol interactions.","volume":"99","author":"Mertens","year":"2003","journal-title":"Anesthesiology."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e97","DOI":"10.1097\/sla.0000000000002263","article-title":"The HIBA index for ALPPS, preliminary results to interpret with caution.","volume":"267","author":"Olthof","year":"2018","journal-title":"Ann Surg."},{"key":"B49","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1097\/sla.0000000000000947","article-title":"Early survival and safety of ALPPS: first report of the International ALPPS registry.","volume":"260","author":"Schadde","year":"2014","journal-title":"Ann Surg."},{"key":"B50","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1002\/cbin.10745","article-title":"Propofol protects against hepatic ischemia\/reperfusion injury via miR-133a-5p regulating the expression of MAPK6.","volume":"41","author":"Hao","year":"2017","journal-title":"Cell Biol Int."},{"key":"B51","first-page":"1085","article-title":"Effects of different duration of sevoflurane anesthesia in neonatal period on long-term cognitive func-tion and hippocampal synaptic plasticity in rats.","author":"Pan","year":"2016","journal-title":"Chinese J Anesthesiol."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1159\/000443103","article-title":"The effects of two anesthetics, propofol and sevoflurane, on liver ischemia\/reperfusion injury.","volume":"38","author":"Xu","year":"2016","journal-title":"Cell Physiol Biochem."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1111\/anae.13578","article-title":"Effects of intra-operative maintenance of general anaesthesia with propofol on postoperative pain outcomes - a systematic review and meta-analysis.","volume":"71","author":"Qiu","year":"2016","journal-title":"Anaesthesia."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1607841\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:44:26Z","timestamp":1770273866000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1607841\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,5]]},"references-count":53,"alternative-id":["10.3389\/fmed.2026.1607841"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1607841","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,5]]},"article-number":"1607841"}}