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Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function.

Publication ,  Journal Article
Kharasch, ED; Frink, EJ; Artru, A; Michalowski, P; Rooke, GA; Nogami, W
Published in: Anesth Analg
December 2001

UNLABELLED: 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. IMPLICATIONS: Postoperative renal function after long-duration low-flow sevoflurane (with Compound A exposures greater than those typically reported) and isoflurane anesthesia were not different, as assessed by serum creatinine, blood urea nitrogen, and urinary excretion of protein and glucose. This suggests that low-flow sevoflurane is as safe as low-flow isoflurane, even at long exposures.

Duke Scholars

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

December 2001

Volume

93

Issue

6

Start / End Page

1511 / 1520

Location

United States

Related Subject Headings

  • Time Factors
  • Sevoflurane
  • Middle Aged
  • Methyl Ethers
  • Male
  • Liver
  • Kidney
  • Isoflurane
  • Hydrocarbons, Fluorinated
  • Humans
 

Citation

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Kharasch, E. D., Frink, E. J., Artru, A., Michalowski, P., Rooke, G. A., & Nogami, W. (2001). Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg, 93(6), 1511–1520. https://doi.org/10.1097/00000539-200112000-00036
Kharasch, E. D., E. J. Frink, A. Artru, P. Michalowski, G. A. Rooke, and W. Nogami. “Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function.Anesth Analg 93, no. 6 (December 2001): 1511–20. https://doi.org/10.1097/00000539-200112000-00036.
Kharasch ED, Frink EJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg. 2001 Dec;93(6):1511–20.
Kharasch, E. D., et al. “Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function.Anesth Analg, vol. 93, no. 6, Dec. 2001, pp. 1511–20. Pubmed, doi:10.1097/00000539-200112000-00036.
Kharasch ED, Frink EJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg. 2001 Dec;93(6):1511–1520.

Published In

Anesth Analg

DOI

ISSN

0003-2999

Publication Date

December 2001

Volume

93

Issue

6

Start / End Page

1511 / 1520

Location

United States

Related Subject Headings

  • Time Factors
  • Sevoflurane
  • Middle Aged
  • Methyl Ethers
  • Male
  • Liver
  • Kidney
  • Isoflurane
  • Hydrocarbons, Fluorinated
  • Humans