Plasma inorganic fluoride with sevoflurane anesthesia

Correlation with indices of hepatic and renal function

E. J. Frink, H. Ghantous, T. P. Malan, S. Morgan, J. Fernando, A Jay Gandolfi, B. R. Brown

Research output: Contribution to journalArticle

108 Citations (Scopus)

Abstract

The biotransformation and plasma inorganic fluoride ion production of sevoflurane (the new volatile anesthetic) during and after surgical anesthesia was studied in 50 ASA I or II surgical patients. Twenty-five additional patients served as controls by receiving isoflurane. Sevoflurane or isoflurane was administered with a semiclosed (total gas flow, 2 L/min O2) circle absorption system for durations of 1.0 to greater than 7.0 minimal alveolar concentration (MAC) hours for surgical anesthesia (sevoflurane MAC, 2.05%; isoflurane MAC, 1.15%). Preoperative and postoperative blood urea nitrogen and creatinine concentrations were determined. Blood samples were obtained during and after anesthesia in both groups for determining anesthetic blood concentration analysis and plasma fluoride level. Plasma fluoride concentrations did not significantly increase during isoflurane anesthesia. Sevoflurane biotransformation produced a mean peak plasma inorganic fluoride concentration of 29.3 ± 1.8 μmol/L, 2 h after anesthesia, which decreased to 18 μmol/L concentration by 8 h after anesthesia. The peak plasma inorganic fluoride ion concentration correlated with duration of sevoflurane anesthetic exposure. Five patients given sevoflurane had peak levels transiently exceeding 50 μmol/L, and one of these had a history of ingesting drugs potentially producing hepatic enzyme induction. No increases in postoperative levels of creatinine, blood urea nitrogen, direct bilirubin, or hepatic transaminase and no changes in serum electrolyte level occurred in either anesthetic group. Indirect bilirubin concentration increased significantly after sevoflurane anesthesia, but the increase was not of clinical significance (from 0.30 ± 0.03 to 0.38 ± 0.06 mg/dL). Indirect bilirubin concentrations did not increase after isoflurane anesthesia; the concentrations reached 0.31 ± 0.04 mg/dL and did not differ significantly from those found with isoflurane. Even though plasma fluoride concentrations increased, no evidence of renal dysfunction occurred.

Original languageEnglish (US)
Pages (from-to)231-235
Number of pages5
JournalAnesthesia and Analgesia
Volume74
Issue number2
StatePublished - 1992

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Fluorides
Isoflurane
Anesthesia
Kidney
Liver
Anesthetics
Bilirubin
Blood Urea Nitrogen
Biotransformation
Creatinine
Ions
Enzyme Induction
sevoflurane
Transaminases
Electrolytes
Gases
Serum
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Frink, E. J., Ghantous, H., Malan, T. P., Morgan, S., Fernando, J., Gandolfi, A. J., & Brown, B. R. (1992). Plasma inorganic fluoride with sevoflurane anesthesia: Correlation with indices of hepatic and renal function. Anesthesia and Analgesia, 74(2), 231-235.

Plasma inorganic fluoride with sevoflurane anesthesia : Correlation with indices of hepatic and renal function. / Frink, E. J.; Ghantous, H.; Malan, T. P.; Morgan, S.; Fernando, J.; Gandolfi, A Jay; Brown, B. R.

In: Anesthesia and Analgesia, Vol. 74, No. 2, 1992, p. 231-235.

Research output: Contribution to journalArticle

Frink, EJ, Ghantous, H, Malan, TP, Morgan, S, Fernando, J, Gandolfi, AJ & Brown, BR 1992, 'Plasma inorganic fluoride with sevoflurane anesthesia: Correlation with indices of hepatic and renal function', Anesthesia and Analgesia, vol. 74, no. 2, pp. 231-235.
Frink, E. J. ; Ghantous, H. ; Malan, T. P. ; Morgan, S. ; Fernando, J. ; Gandolfi, A Jay ; Brown, B. R. / Plasma inorganic fluoride with sevoflurane anesthesia : Correlation with indices of hepatic and renal function. In: Anesthesia and Analgesia. 1992 ; Vol. 74, No. 2. pp. 231-235.
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abstract = "The biotransformation and plasma inorganic fluoride ion production of sevoflurane (the new volatile anesthetic) during and after surgical anesthesia was studied in 50 ASA I or II surgical patients. Twenty-five additional patients served as controls by receiving isoflurane. Sevoflurane or isoflurane was administered with a semiclosed (total gas flow, 2 L/min O2) circle absorption system for durations of 1.0 to greater than 7.0 minimal alveolar concentration (MAC) hours for surgical anesthesia (sevoflurane MAC, 2.05{\%}; isoflurane MAC, 1.15{\%}). Preoperative and postoperative blood urea nitrogen and creatinine concentrations were determined. Blood samples were obtained during and after anesthesia in both groups for determining anesthetic blood concentration analysis and plasma fluoride level. Plasma fluoride concentrations did not significantly increase during isoflurane anesthesia. Sevoflurane biotransformation produced a mean peak plasma inorganic fluoride concentration of 29.3 ± 1.8 μmol/L, 2 h after anesthesia, which decreased to 18 μmol/L concentration by 8 h after anesthesia. The peak plasma inorganic fluoride ion concentration correlated with duration of sevoflurane anesthetic exposure. Five patients given sevoflurane had peak levels transiently exceeding 50 μmol/L, and one of these had a history of ingesting drugs potentially producing hepatic enzyme induction. No increases in postoperative levels of creatinine, blood urea nitrogen, direct bilirubin, or hepatic transaminase and no changes in serum electrolyte level occurred in either anesthetic group. Indirect bilirubin concentration increased significantly after sevoflurane anesthesia, but the increase was not of clinical significance (from 0.30 ± 0.03 to 0.38 ± 0.06 mg/dL). Indirect bilirubin concentrations did not increase after isoflurane anesthesia; the concentrations reached 0.31 ± 0.04 mg/dL and did not differ significantly from those found with isoflurane. Even though plasma fluoride concentrations increased, no evidence of renal dysfunction occurred.",
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