CLINICAL CHARACTERISTICS AND BIOTRANSFORMATION OF SEVOFLURANE IN PEDIATRIC-PATIENTS DURING ANTIEPILEPTIC DRUG-THERAPY

Patients with epilepsy on long term antiepileptic drug (AED) therapy d eserve special consideration not only concerning seizure control but a lso the effect on anaesthetic metabolism and hepatorenal functions. In the present study, we examined the effects of sevoflurane anaesthesia on plasma inorganic fluoride (F-) level and hepatorenal function in p atients with and without AED therapy. Twenty-two patients (12 with AED s = AED group, and ten without AEDs = control group = C group), ASA I, who were free of hepatorenal disease, received approximately 2-3 h se voflurane anaesthesia. Plasma F- analysis was performed at the stages of: 1) induction of anaesthesia, 2) conclusion of anaesthesia, 3) 15 h after the conclusion of anaesthesia, using an ion-selective electrode calibrated with a standard solution of sodium fluoride. Pre- and post operative hepatic (aspartate aminotransferase, alanine aminotransferas e, alkaline phosphatase, total bilirubin) and renal (blood urea nitrog en, creatinine) function was tested. There were no significant differe nces between the two groups in the average age (AED group = 9.4 and co ntrol group = 10.1 y.o.), body weight, duration of anesthesia, and MAC hours (2.6 and 2.4). The mean peak F- levels were 15.5 and 13.6 mu M, in AED and C groups (not significant), respectively. No patient exhib ited F- values greater than 50 mu M, the hypothetical nephrotoxic thre shold. The patients showed no abnormal values either in hepatic or ren al function tests postoperatively. These results suggest approximately 2-3 h sevoflurane anaesthesia to be safe in patients taking AEDs.