Search Results (247)

Background and Objectives: Immediately after thyroidectomy, retching driven by postoperative nausea and vomiting (PONV) may cause wound rupture, severe bleeding, and airway obstruction. Although inhaled anesthetics are widely used in thyroidectomy, they may increase the postoperative risk of PONV. Therefore, this study aimed to compare PONV incidence and recovery patterns according to the characteristics of sevoflurane (Sevo) and desflurane (Des) when remifentanil was continuously infused until extubation. Materials and Methods: This retrospective cohort study involved 70 female patients undergoing elective thyroidectomy, who were categorized into the Sevo (n = 35) and Des (n = 35) groups. Remifentanil was administered at an effect-site concentration of 2 ng/mL during emergence. Results: PONV incidence during emergence was 20% in both groups (p = 1.000). The Des group had shorter times to recovery of consciousness and extubation than the Sevo group (p < 0.001 and p < 0.001, respectively). At 5 min after extubation, patients in the Des group were more alert (p = 0.001), with 54.3% awake and responsive. Postanesthesia care unit stay was also shorter in the Des group (16.89 ± 3.22 vs. 23.74 ± 4.80; p < 0.001). Additionally, perioperative hemodynamic status, surgical site pain, and residual sedation did not differ between inhaled anesthetics. Conclusions: When remifentanil was infused until extubation after thyroidectomy, the choice of inhaled anesthetics did not affect the incidence of acute PONV. Des provided faster early recovery without additional side effects than Sevo; nonetheless, acute recovery profiles did not differ between inhaled anesthetics. Full article

Background and Objectives: Sevoflurane, a widely used inhalational anesthetic, is frequently administered during hepatocellular carcinoma (HCC) surgery, including hepatic resection and orthotopic liver transplantation. Because such procedures often require prolonged anesthetic exposure, the potential influence of sevoflurane on HCC cell behavior is of clinical interest. We aimed to evaluate the effects of sevoflurane on the proliferation and migration of HepG2 cells in vitro and on tumor growth in a xenograft mouse model in vivo, and to explore whether hypoxia-inducible factor-1α (HIF-1α) might be involved in this process. Materials and Methods: For the in vitro experiments, HepG2 cells were exposed to room air (0%), 2%, or 4% sevoflurane. A scratch wound healing assay was used to assess cell migration, and the number of viable cells was quantified by hemocytometer counting on day 4 to estimate proliferation. For the in vivo experiments, BALB/c nude mice bearing HepG2 xenografts were exposed to room air, 2% sevoflurane, or 4% sevoflurane for 3 h, three times weekly for 5 weeks. Tumor size and tumor weight were measured at the end of the exposure period. HIF-1α protein levels in tumor tissue were measured by enzyme-linked immunosorbent assay (ELISA) in tumor lysates and normalized to total tumor protein as an exploratory mechanistic analysis. Given the small sample available for this endpoint, the analysis had limited sensitivity to detect modest differences. Results: When wound closure was quantified and pooled across the analyzable experiments, no statistically significant difference was detected among the room air, 2% sevoflurane, and 4% sevoflurane groups (day-2 closure 19.9 ± 32.1%, 22.1 ± 25.8%, and 22.3 ± 28.8%, respectively; repeated-measures ANOVA p = 0.82), with variability dominated by between-experiment rather than treatment differences. In the proliferation assay, the number of viable HepG2 cells on day 4 was significantly lower in the 2% sevoflurane group (62.6 ± 3.3 × 10⁵) than in the room air group (68.5 ± 4.2 × 10⁵; p < 0.05); the 4% sevoflurane group (66.0 ± 3.2 × 10⁵) showed an intermediate value that did not reach statistical significance. In the xenograft model, mean tumor size in the room air, 2% sevoflurane, and 4% sevoflurane groups was 7.1 ± 1.9, 2.7 ± 2.0, and 2.1 ± 0.9 cm³, respectively (p = 0.041 for room air vs. 2% sevoflurane; p = 0.034 for room air vs. 4% sevoflurane). Tumor weight was likewise lower in the sevoflurane groups (room air, 7.88 ± 2.2 g; 2% sevoflurane, 2.95 ± 2.1 g; 4% sevoflurane, 2.3 ± 1.6 g; p = 0.044 for room air vs. 2% sevoflurane; p = 0.067 for room air vs. 4% sevoflurane). No statistically significant differences in tumor HIF-1α protein levels were observed among the three groups. Conclusions: In this exploratory study, sevoflurane exposure was associated with reduced HepG2 xenograft tumor growth in vivo, whereas its in vitro effects were more limited: a reduction in viable cell number was observed only at 2% sevoflurane, and an effect on cell migration could not be confirmed when analyzed across experiments. Tumor HIF-1α levels did not differ significantly between groups, suggesting that other molecular pathways may be involved. Further mechanistic and clinical studies are warranted before any conclusions can be drawn about the relevance of these findings to the perioperative management of patients with HCC. Full article

Background: Designing studies to increase knowledge of the beneficial effects of volatile halogenated anaesthetics(VHAs) is critical to understand the mechanisms activated by myocardial conditioning during ischaemia-reperfusion(I/R) injury. Our research group has identified specific enzymes associated with the SAFE/RISK signalling pathways involved in halogen-induced cardioprotection and has observed a direct correlation between the expression of specific microRNA(miRNAs) and the cardioprotective effect conferred by VHA. Objective: This protocol study has been designed to increase knowledge regarding the cardioprotective effects generated by induced cardioprotective miRNAs after exposure to halogenated drugs without subjecting the patient to additional surgical procedures. Methods: The experimental design that is proposed will be performed with isogenic Wistar rats, all subjected to an I/R procedure. The animals will be randomly divided into two groups: the Donor group and the Recipient group. Half of the rats included in both groups will be exposed to sevoflurane (S), a hypnotic drug, during the I/R procedure, and the other half will be injected with propofol (P), a hypnotic. EVs will be isolated from plasma samples extracted from rats in the Donor group 24 h after the I/R procedure. In vitro EV characterisation will be performed by conducting an ultramorphological analysis, identifying the EV immunophenotype, and quantifying miRNAs. Cardiac function will be assessed by transthoracic echocardiography, histological, and immunohistochemical analyses. Results: The results derived from studies conducted according to this experimental design will support its validation as a preclinical study by regulatory authorities for approval and will serve to design a Phase I clinical trial. Conclusions: The proposed scientific rationale of applying this proposed experimental design will enable the generation of knowledge ‘from the bench to the bedside’ regarding miRNAs with cardioprotective properties induced by exposure to halogenated agents, which could be considered as biomarkers of cardioprotection. Furthermore, biomarker administration could reduce cardiac damage in patients undergoing additional cardiac surgery. Full article

Inhalational anesthesia, which includes anesthetics such as sevoflurane, isoflurane, and desflurane, is widely used in clinical settings for surgical interventions across all age groups. Nonetheless, recent findings from preclinical research raise important questions regarding their potential neurotoxic effects, especially within the developing brain, though clinical implications remain to be fully established. This narrative review was conducted through a literature search of the PubMed database and synthesizes preclinical investigations into gene modifications associated with neurotoxicity following exposure to inhalation anesthetics. Emphasis was placed on anesthetic exposure in human and animal-derived cell lines, neurodevelopmental animal models, as well as adult and aged animals. In various models, the neurotoxic mechanisms of inhalational anesthesia involve a complex interaction of apoptosis, oxidative stress, mitochondrial dysfunction, neuroinflammation, and epigenetic remodeling. Developmental studies indicate additional susceptibilities, including impaired neuronal migration, myelination deficits, and transgenerational epigenetic effects, whereas aging models exhibit oxidative stress injury, microglial activation, and heightened perioperative neurocognitive sensitivity. Understanding these neurotoxic mechanisms is essential for identifying risk factors, formulating age-specific neuroprotective strategies, and enhancing the overall safety of anesthetic use, particularly in vulnerable populations. Full article

Background and Objectives: Emergence agitation (EA) is a common neurobehavioral disturbance during recovery from sevoflurane anesthesia in pediatric patients, particularly after ophthalmic surgery. Clinically deployable and rigorously validated risk stratification approaches remain limited. We aimed to develop and internally validate an explainable machine learning model to estimate individualized EA risk after pediatric ophthalmic surgery. Materials and Methods: This retrospective cohort study included 1029 children aged 3–7 years who underwent ophthalmic surgery under sevoflurane anesthesia between 2016 and 2025. EA was defined as clinically significant agitation requiring active management in the post-anesthesia care unit. Four machine learning algorithms (regularized logistic regression, random forest, XGBoost, and CatBoost) were developed using stratified patient-level 5-fold cross-validation. Performance was evaluated using pooled out-of-fold predictions. Discrimination, calibration, and classification metrics at the optimal Youden threshold were assessed. SHAP analysis was applied for interpretability. Results: EA occurred in 543 patients (52.8%). XGBoost showed comparable discrimination with slightly higher AUPRC (0.827) and sensitivity (0.796) compared with other models, while maintaining acceptable specificity (0.728). Calibration demonstrated good agreement between predicted and observed risk. SHAP identified airway management and anesthetic-related variables as key contributors. Conclusions: ML-based analysis identified clinically relevant perioperative factors associated with emergence agitation and may provide preliminary insight into perioperative risk stratification pending external validation. External validation is required before clinical implementation. Full article

Postoperative delirium (POD) is an acute, reversible neurocognitive disorder characterized by confusion and altered consciousness. With the improvement in research methodologies and the introduction of innovative clinical drugs in recent years, a growing number of randomized controlled trials have been conducted. This article aims to conduct a comprehensive review of the efficacy of general anesthetics—including propofol, ciprofol, sevoflurane, ketamine, esketamine, dexmedetomidine, benzodiazepines, opioids, and lidocaine—in preventing and managing POD, based on randomized controlled trials published in the past five years. Propofol has advantages in preventing POD in pediatric patients. However, its efficacy compared with inhalational anesthetics still requires individualized evaluation in elderly patients. The novel drugs ciprofol and remimazolam exhibit favorable safety profiles and do not increase the risk of POD. The efficacy of dexmedetomidine shows variability across patient populations and surgical types. In addition, specific opioid drugs and lidocaine also demonstrate preventive potential when administered in a standardized manner. Full article

Background: Cognitive changes after minor surgery may affect patient safety, functional recovery, and readiness for hospital discharge, even after low-risk procedures with early discharge protocols. In this regard, patients require neuropsychological assessment at discharge, which may have important clinical implications for return to daily activities and postoperative decision-making. Our study investigated postoperative cognitive changes after minor surgery under general anesthesia using a neuropsychological assessment and a non-surgical group. Methods: Patients undergoing laparoscopic cholecystectomy received propofol or sevoflurane anesthesia. A non-surgical control group was included. Cognitive performance was assessed at baseline and discharge using the Computerized Visual Attention Test (CVAT), the controlled oral word association test (COWAT), and the symbol digit modalities test (SDMT). Relative change scores were calculated as ((baseline − postoperative performance)/baseline). Group differences were analyzed using two-tailed multivariate analysis of variance (MANOVA), followed by ANOVAs and Bonferroni-adjusted pairwise comparisons. Results: A total of 105 participants were included (37 non-surgical, 34 propofol, 34 sevoflurane). MANOVA showed a significant group effect (Pillai’s trace = 0.332, p < 0.001, η² = 0.196). The ANOVAs revealed significant differences in sustained attention (CVAT), verbal fluency (COWAT) and executive function (SDMT). The propofol group showed evident decline in sustained attention compared to non-surgical. In verbal fluency, non-surgical improved at day after, whereas both surgical groups showed no improvement, indicating worse performance. In SDMT the sevoflurane group had worse performance. Conclusions: Minor surgery under general anesthesia may lead to transient impairments in attention and learning at discharge, supporting the need for postoperative cognitive monitoring and individualized discharge decisions. Full article

Background/Objectives: Whether anesthetic maintenance influences tumor biology in cervical cancer remains unsettled. We examined whether plasma extracellular vesicles (EVs) collected during sevoflurane or propofol anesthesia differentially affect HeLa cell behavior and explored lipidomic alterations associated with the biologically active EV condition. Methods: In a single-center prospective observational cohort, paired plasma samples were collected before anesthesia induction and before wound closure from 53 patients with stage II cervical cancer undergoing radical surgery under sevoflurane (n = 28) or propofol (n = 25) anesthesia. EV preparations were characterized by transmission electron microscopy, nanoparticle tracking analysis, and immunoblotting for EV markers. Their effects on HeLa cell proliferation, invasion, and wound closure, as well as HUVEC tube formation, were examined in vitro. EV miRNA profiles were analyzed by small-RNA sequencing. Lipidomic profiling by LC-MS and immunoblot analysis of EGFR/PKCα/NF-κB signaling were performed in recipient HeLa cells exposed to sevoflurane-associated EVs. Results: EVs collected after sevoflurane anesthesia increased HeLa cell proliferation, invasion, and wound closure and enhanced endothelial branching in HUVEC tube-formation assays, whereas post-propofol EVs showed no comparable phenotype. Small-RNA sequencing identified distinct anesthesia-associated EV miRNA changes, with the sevoflurane-related signature enriched in glycerolipid metabolism, glycerophospholipid metabolism, glycosylphosphatidylinositol-anchor biosynthesis, phosphatidylinositol signaling, and inositol phosphate metabolism. In HeLa cells treated with post-sevoflurane EVs, lipidomic analysis showed clear separation from pre-sevoflurane EV-treated cells and identified increased diacylglycerol (DG) species, including DG (16:1/18:2), DG (16:0/16:1), DG (18:2/18:2), DG (18:2/20:4), and DG (16:0/18:2). These changes were accompanied by higher p-EGFR, PKCα, and p-NF-κB p65 levels. Several DG species correlated positively with proliferation and invasion readouts and inversely with residual wound area. Conclusions: Plasma EVs collected after sevoflurane anesthesia were associated with a more aggressive phenotype in recipient cervical cancer cells and with lipid remodeling characterized by DG accumulation and altered EGFR/PKCα/NF-κB signaling. The data support an exploratory mechanistic model linking sevoflurane-associated EV cargo to metabolic reprogramming in cervical cancer cells. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) remain frequent after breast surgery despite prophylaxis. This single-center, parallel-group randomized controlled trial evaluated whether intraoperative opioid-sparing anesthesia using dexmedetomidine and lidocaine reduced 48 h PONV compared with opioid-based anesthesia. Methods: Adult women undergoing elective breast surgery were randomized 1:1 to opioid-sparing anesthesia with dexmedetomidine and lidocaine or conventional opioid-based anesthesia with remifentanil. Participants and postoperative outcome assessors were blinded to group allocation; attending anesthesiologists were not blinded. All patients received standardized sevoflurane anesthesia, dexamethasone, ramosetron, quantitative neuromuscular monitoring, and postoperative fentanyl patient-controlled analgesia. The primary outcome was PONV within 48 h after surgery. Results: Among 68 randomized patients, 67 were analyzed (opioid-sparing group, n = 33; control group, n = 34). PONV within 48 h occurred in 8 patients (24.2%) in the opioid-sparing group and 28 patients (82.4%) in the control group (risk ratio, 0.29; 95% confidence interval, 0.16–0.55; p < 0.001; absolute risk reduction, 58.1%; number needed to treat, 1.7). Rescue antiemetic use was lower in the opioid-sparing group in the postanesthesia care unit and at 1 h postoperatively. Pain scores and cumulative opioid consumption were comparable. No Clavien–Dindo grade III or higher complications occurred. Conclusions: Intraoperative opioid-sparing anesthesia was associated with lower 48 h PONV after breast surgery without apparent compromise in analgesia. These single-center findings, from a trial registered after enrollment of one participant, require confirmation in larger prospectively registered multicenter trials. Trial Registration: Clinical Research Information Service (CRIS), KCT0009829. Registered on 10 October 2024. Full article

During deep anesthesia, the EEG becomes discontinuous. Burst-suppression is often an intended target during deep sedation or medically induced coma. Within this state, anesthetic depth is commonly monitored by the suppression ratio (SR), which expresses the fraction of time spent in suppression. However, accumulating evidence suggests that SR remains reactive to external stimulation. We tested whether ambient music commonly played in operating theaters alters the SR in male Wistar rats under sevoflurane, chloral hydrate, or isoflurane anesthesia. To this end, the first 60 s of the Stayin’ Alive audio track by the Bee Gees were played to examine auditory-induced burst-suppression reactivity in an experimental model previously established for intermittent photic stimulation. SR and the burst-suppression reactivity index (BSRi, derived as the decrease in SR during stimulation normalized to pre-stimulation SR) were measured in repeated trials. Auditory stimulation transiently decreased SR under all three anesthetics. This was associated with an increase in the rate of burst occurrence without increased burst duration. The BSRi changes depended on the anesthetic type, comparable to photic stimulation. Our experimental data suggest that the suppression ratio used to monitor targeted burst-suppression reflects both anesthetic depth and the level of ambient stimulation. Ambient sound in the operating theater or intensive care settings could influence EEG-based measures used for anesthesia monitoring. Full article

Background and Objectives: Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical field visibility but may pose a risk of subclinical cerebral hypoperfusion. Serum S100Β and neuron-specific enolase (NSE) are established biomarkers of glial and neuronal injury and may reflect perioperative neuroprotection associated with different anesthetic regimens. This study evaluated the effect of four anesthetic protocols on perioperative brain biomarker release during FESS. Materials and Methods: In this single-center, randomized, controlled trial, 88 adult patients (ASA I–III) undergoing FESS under moderately controlled hypotension (mean arterial pressure < 55 mmHg) were allocated to one of four groups: propofol–remifentanil, propofol–remifentanil with ketamine–magnesium, sevoflurane–remifentanil, or sevoflurane–remifentanil with ketamine–magnesium. Serum S100Β and NSE concentrations were measured at three timepoints: early intraoperatively, during hypotension, and at the end of surgery. Biomarker data were analyzed using nested ANOVA and linear mixed-effects models adjusted for relevant covariates. Secondary outcomes included recovery characteristics, surgical field quality, bleeding scores, and perioperative hemodynamics. Results: Baseline demographic and perioperative characteristics were comparable across groups. The group receiving sevoflurane–remifentanil combined with ketamine–magnesium showed the lowest S100B levels (p = 0.01 compared to the propofol–remifentanil group; p = 0.04 compared to the sevoflurane–remifentanil group). Additionally, NSE concentrations were markedly lower in both sevoflurane groups (sevoflurane–remifentanil and sevoflurane–remifentanil plus ketamine–magnesium) compared to the propofol–remifentanil group (p = 0.003 and p = 0.007, respectively). No intergroup differences were observed at baseline and surgical field quality, bleeding, and hemodynamic parameters did not differ significantly among groups. Recovery and extubation times were shortest with propofol–remifentanil, whereas ketamine–magnesium prolonged emergence. Conclusions: Anesthetic technique significantly influences perioperative brain biomarker release during FESS. Sevoflurane-based regimens, with or without ketamine–magnesium, demonstrate more favorable neurobiological profiles under controlled hypotension, although propofol-based anesthesia offers faster recovery. Full article

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time. Full article

Background and Objectives: Sevoflurane, a widely used volatile anesthetic, can induce oxidative stress and apoptosis, but the underlying mechanisms in human cardiomyocytes remain unclear. This study investigated the role of transient receptor potential vanilloid 1 (TRPV1) channels in sevoflurane-induced cardiotoxicity and the potential mitigating effect of ascorbic acid. Materials and Methods: Human cardiomyocytes were exposed to sevoflurane (5.1%, 6 h) and/or ascorbic acid (1 mM, 30 min), with or without the TRPV1 channel antagonist capsazepine and with the TRPV1 channel agonist Capsaicin. Intracellular calcium, reactive oxygen species (ROS), apoptosis, mitochondrial membrane potential, and caspase-3/9 activities were assessed. Results: Sevoflurane significantly increased intracellular calcium levels, ROS production, mitochondrial depolarization, apoptosis, and caspase-3/9 activity compared with controls (p < 0.001). These effects were attenuated by capsazepine, suggesting a role for TRPV1 involvement. Ascorbic acid pretreatment significantly reduced sevoflurane-induced elevations in all parameters (p < 0.001). Combined ascorbic acid and capsazepine treatment yielded further reductions in calcium, ROS, apoptosis, and caspase activities compared to ascorbic acid alone (p < 0.05). Conclusions: Sevoflurane induces apoptosis in human cardiomyocytes via ROS-mediated activation of the TRPV1 channel, leading to calcium overload, mitochondrial dysfunction, and caspase-dependent cell death. Ascorbic acid exerts mitigating effects by reducing oxidative stress and modulating TRPV1 channel activity, suggesting a potential therapeutic strategy for myocardial protection during sevoflurane anesthesia. Full article

Background: The trigeminocardiac reflex (TCR) is a potent brainstem response often underrecognized during pediatric dental procedures. We aimed to quantify TCR dynamics, identifying procedural and temporal predictors of occurrence and resolution. Methods: We conducted a prospective observational study (NCT07240688) in pediatric patients undergoing dental procedures under standardized sevoflurane anesthesia. TCR was defined as a ≥10% (mild) or ≥20% (severe) abrupt decrease in heart rate (HR) and/or mean arterial blood pressure (MABP). Data were analyzed using Generalized Estimating Equations (GEE) and hierarchical logistic regression to identify procedural risk factors and recovery dynamics. Results: The study included 85 pediatric patients (aged 2–9 years) undergoing 1115 monitored dental procedures. The overall TCR incidence was 82.3% (n = 70). Operative duration was the strongest predictor of occurrence; each 1 min increase raised TCR odds by 6.7% (aOR: 1.067, p < 0.001). A landmark “60-min Autonomic Cliff” was identified: the probability of rapid spontaneous recovery dropped from 97.1% before 60 min to 0.0% thereafter (p < 0.001). Pulpal involvement was associated with a 3.37-fold increase in odds of severe TCR (Cramer’s V = 0.747). While lingual manipulation was strongly associated with rapid resolution (OR: 650.04), deep pulpal maneuvers led to a state of “Vagal Lock-in”—a sustained bradycardic response with reduced spontaneous recovery—effectively neutralized by atropine (97.0% success). Conclusions: Pediatric TCR is a time-dependent autonomic phenomenon in which operative duration influences reflex susceptibility and recovery dynamics, without affecting reflex severity. Beyond the “60-min Autonomic Cliff,” spontaneous recovery becomes unlikely, marking a transition to a refractory physiological state rather than an increase in reflex severity. This threshold provides a clinically actionable signal for anesthesiologists to intensify monitoring and consider early vagolytic intervention, supporting anticipatory, time-guided intraoperative management. Full article

Background and Objectives: While liver transplantation (LT) is a definitive treatment for hepatocellular carcinoma (HCC), tumor recurrence remains a major clinical concern. Although volatile anesthetics influence oncological outcomes, direct comparison between sevoflurane and desflurane remains scarce. This study aimed to investigate the impact of the recipient’s volatile anesthetic choice (sevoflurane vs. desflurane) on HCC recurrence following living donor liver transplantation (LDLT). Materials and Methods: This retrospective cohort study included adult patients who underwent LDLT for HCC. Patients were then divided into sevoflurane and desflurane groups, and propensity score matching (PSM) was used to balance baseline variables. The primary outcome was HCC recurrence, and the secondary outcomes were overall survival (OS) and postoperative C-reactive protein (CRP) levels as a marker for the postoperative systemic inflammatory response. Results: After PSM, 373 matched pairs (n = 746) were analyzed. HCC recurrence was significantly higher in the sevoflurane group compared to the desflurane group (19.6% vs. 13.1%, p = 0.023). Kaplan–Meier analysis also demonstrated that cumulative recurrence of HCC was significantly higher in recipients who received sevoflurane anesthesia than in those who received desflurane (log-rank p = 0.0018). In multivariate Cox proportional hazards regression analysis, the use of sevoflurane for anesthesia maintenance was an independent risk factor forHCC recurrence (Hazard Ratio, 1.66; 95% Confidence Interval, 1.15–2.39; p = 0.007). Regarding OS, no significant difference was observed between the two groups (log-rank p = 0.1123). Postoperative CRP levels were significantly higher in the sevoflurane group compared to the desflurane group, suggesting a more intense systemic inflammatory response associated with sevoflurane maintenance. Conclusions: For HCC patients undergoing LDLT, anesthesia maintenance with desflurane is associated with a reduced risk of tumor recurrence compared to sevoflurane, without a significant impact on overall survival. Full article