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

Evan D. Kharasch, Edward J. Frink, Alan Artru, Piotr Michalowski, G. Alec Rooke, Wallace M Nogami

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)1511-1520
Number of pages10
JournalAnesthesia and Analgesia
Volume93
Issue number6
StatePublished - 2001

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Isoflurane
Kidney
Anesthetics
Liver
Anesthesia
Proteinuria
Creatinine
Blood Urea Nitrogen
Nitrous Oxide
Aspartate Aminotransferases
sevoflurane
Alanine Transaminase
Carbon Dioxide
Opioid Analgesics
Urine
Weights and Measures
Glucose
Serum
Proteins

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Kharasch, E. D., Frink, E. J., Artru, A., Michalowski, P., Rooke, G. A., & Nogami, W. M. (2001). Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesthesia and Analgesia, 93(6), 1511-1520.

Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. / Kharasch, Evan D.; Frink, Edward J.; Artru, Alan; Michalowski, Piotr; Rooke, G. Alec; Nogami, Wallace M.

In: Anesthesia and Analgesia, Vol. 93, No. 6, 2001, p. 1511-1520.

Research output: Contribution to journalArticle

Kharasch, ED, Frink, EJ, Artru, A, Michalowski, P, Rooke, GA & Nogami, WM 2001, 'Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function', Anesthesia and Analgesia, vol. 93, no. 6, pp. 1511-1520.
Kharasch, Evan D. ; Frink, Edward J. ; Artru, Alan ; Michalowski, Piotr ; Rooke, G. Alec ; Nogami, Wallace M. / Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. In: Anesthesia and Analgesia. 2001 ; Vol. 93, No. 6. pp. 1511-1520.
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