Beck‐Shimmer 2008.

Methods	Randomised clinical trial.
Participants	Country: Switzerland. Number randomised: initially 70, post randomisation drop outs 6, final participants number 64. Mean age: 56 years. Females: 29 (45.3%). Cirrhotic livers: 0 Steatotic livers: 30 (46.9%). Inclusion criteria: Elective liver resection with inflow occlusion for at least 30 minutes. Exclusion criteria: 1. Age < 18 years old. 2. Liver cirrhosis. 3. Additional ablation therapies (cryosurgery or radiofrequency). 4. Living donors. 5. Liver resections without inflow occlusion.
Interventions	Participants were randomly assigned to two groups: Intervention group 1: during the 30 minutes before commencing liver vascular occlusion, propofol anaesthesia was stopped and replaced by sevoflurane. On commencing the vascular occlusion sevoflurane was stopped and propofol infusion was recommenced (n = 30). Intervention group 2: propofol infusion was continually administered (not stopped during the 30 minutes preceding induction of liver ischaemia) from the start to the end of the operation (n = 34).
Outcomes	The outcomes reported were mortality, liver decompensation, intra‐abdominal infections, bile leak, postoperative bleeding, ITU stay, hospital stay, markers of liver function (bilirubin), and enzyme markers of liver injury.
Notes	We contacted the authors for information regarding blinding of participants and trial investigators, and post operative complications (questions sent January 2009; replies received February 2009). The authors provided this information. Reasons for drop‐outs: intervention group 1: delay of than 30 minutes between commencing sevoflurane anaesthesia and commencement of liver vascular occlusion (4); intervention group 2: liver vascular occlusion not required (2).
Risk of bias
Bias	Authors' judgement	Support for judgement
Adequate sequence generation?	Low risk	Quote: "The randomization sequence without any stratification was generated by computer and sealed".
Allocation concealment?	Unclear risk	Quote: "consecutively numbered envelopes provided concealment of random allocation".
Blinding? All outcomes	Low risk	Quote: "Each patient was operated under the supervision of 1 of 2 blinded, experienced hepatobiliary surgeons". "The patients were blinded" (author replies). "The anaesthetists who administered sevoflurane were not involved in further care of the patients including administration of anaesthesia" (author replies).
Incomplete outcome data addressed? outcomes 2‐4 weeks	High risk	Comment: post‐randomisation drop‐outs could be related to outcomes.
Free of selective reporting?	Low risk	Comment: important outcomes reported.
Free from baseline imbalance?	Low risk	Comment: no baseline imbalance in important characteristics.
Free from academic bias?	Low risk	Comment: no previous published studies of the same comparison by the trial authors.
Free from source of funding bias?	High risk	Quote: "The study was supported by Swiss National Science Foundation grant 3200B0‐109906 (to P.A.C.) and 3200B0‐109558 (to B.B.S.); Abbott AG, Baar Switzerland."