TY - JOUR
T1 - Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function
AU - Kharasch, Evan D.
AU - Frink, Edward J.
AU - Artru, Alan
AU - Michalowski, Piotr
AU - Rooke, G. Alec
AU - Nogami, Wallace
PY - 2001
Y1 - 2001
N2 - Sevoflurane degradation by carbon dioxide absorbents during low-flow anesthesia forms the haloalkene Compound A, which causes nephrotoxicity in rats. Numerous studies have shown no effects of Compound A formation on postoperative renal function after moderate-duration (3-4 h) low-flow sevoflurane; however, effects of longer exposures remain unresolved. We compared renal function after long-duration low-flow (<1 L/min) sevoflurane and isoflurane anesthesia in consenting surgical patients with normal renal function. To maximize degradant exposure, Baralyme® was used, and anesthetic concentrations were maximized (no nitrous oxide and minimal opioids). Inspired and expired Compound A concentrations were quantified. Blood and urine were obtained for laboratory evaluation. Sevoflurane (n = 28) and isoflurane (n = 27) groups were similar with respect to age, sex, weight, ASA status, and anesthetic duration (9.1 ± 3.0 and 8.2 ± 3.0 h, mean ± SD) and exposure (9.2 ± 3.6 and 9.1 ± 3.7 minimum alveolar anesthetic concentration hours). Maximum inspired Compound A was 25 ± 9 ppm(range, 6-49 ppm), and exposure (area under the concentration-time curve) was 165 ± 95 (35-428) ppm·h. There was no significant difference between anesthetic groups in 24- or 72-h serum creatinine, blood urea nitrogen, creatinine clearance, or 0- to 24-h or 48- to 72-h urinary protein or glucose excretion. Proteinuria and glucosuria were common in both groups. There was no correlation between Compound A exposure and any renal function measure. There was no difference between anesthetic groups in 24- or 72-h aspartate aminotransferase or alanine aminotransferase. These results show that the renal and hepatic effects of long-duration low-flow sevoflurane and isoflurane were similar. No evidence for low-flow sevoflurane nephrotoxicity was observed, even at high Compound A exposures as long as 17 h. Proteinuria and glucosuria were common and nonspecific postoperative findings. Long-duration low-flow sevoflurane seems as safe as long-duration low-flow isoflurane anesthesia.
AB - Sevoflurane degradation by carbon dioxide absorbents during low-flow anesthesia forms the haloalkene Compound A, which causes nephrotoxicity in rats. Numerous studies have shown no effects of Compound A formation on postoperative renal function after moderate-duration (3-4 h) low-flow sevoflurane; however, effects of longer exposures remain unresolved. We compared renal function after long-duration low-flow (<1 L/min) sevoflurane and isoflurane anesthesia in consenting surgical patients with normal renal function. To maximize degradant exposure, Baralyme® was used, and anesthetic concentrations were maximized (no nitrous oxide and minimal opioids). Inspired and expired Compound A concentrations were quantified. Blood and urine were obtained for laboratory evaluation. Sevoflurane (n = 28) and isoflurane (n = 27) groups were similar with respect to age, sex, weight, ASA status, and anesthetic duration (9.1 ± 3.0 and 8.2 ± 3.0 h, mean ± SD) and exposure (9.2 ± 3.6 and 9.1 ± 3.7 minimum alveolar anesthetic concentration hours). Maximum inspired Compound A was 25 ± 9 ppm(range, 6-49 ppm), and exposure (area under the concentration-time curve) was 165 ± 95 (35-428) ppm·h. There was no significant difference between anesthetic groups in 24- or 72-h serum creatinine, blood urea nitrogen, creatinine clearance, or 0- to 24-h or 48- to 72-h urinary protein or glucose excretion. Proteinuria and glucosuria were common in both groups. There was no correlation between Compound A exposure and any renal function measure. There was no difference between anesthetic groups in 24- or 72-h aspartate aminotransferase or alanine aminotransferase. These results show that the renal and hepatic effects of long-duration low-flow sevoflurane and isoflurane were similar. No evidence for low-flow sevoflurane nephrotoxicity was observed, even at high Compound A exposures as long as 17 h. Proteinuria and glucosuria were common and nonspecific postoperative findings. Long-duration low-flow sevoflurane seems as safe as long-duration low-flow isoflurane anesthesia.
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U2 - 10.1097/00000539-200112000-00036
DO - 10.1097/00000539-200112000-00036
M3 - Article
C2 - 11726433
AN - SCOPUS:0035201028
SN - 0003-2999
VL - 93
SP - 1511
EP - 1520
JO - Anesthesia and analgesia
JF - Anesthesia and analgesia
IS - 6
ER -