ABSENCE OF BIOCHEMICAL-EVIDENCE FOR RENAL AND HEPATIC-DYSFUNCTION AFTER 8 HOURS OF 1.25 MINIMUM ALVEOLAR CONCENTRATION SEVOFLURANE ANESTHESIA IN VOLUNTEERS

Background: Sevoflurane is degraded by carbon dioxide absorbents to a difluorovinyl ether (compound A) that can cause renal and hepatic inju ry in rats, The present study applied sensitive markers of renal and h epatic function to determine the safety of prolonged (8 h), high conce ntration (3% end-tidal) sevoflurane anesthesia in human volunteers. Me thods: Thirteen healthy male volunteers provided informed consent to u ndergo 8 h of 1.25 minimum alveolar concentration sevoflurane anesthes ia delivered with a fresh gas now of 2 l/min. Glucose, protein, albumi n, N-acetyl-beta-D-glucosaminidase (NAG), and alpha- and pi-glutathion e-S-transferase (GST) levels were analyzed in urine collected at 24 h before and for 3 days after sevoflurane anesthesia, Daily blood sample s were analyzed for creatinine, blood urea nitrogen (BUN), alanine ami notransferase, alkaline phosphatase, and bilirubin concentrations, Cir cuit compound A and plasma fluoride concentrations were measured. Resu lts: During anesthesia, average and maximum inspired compound A concen trations were 27 +/- 7 and 34 +/- 6 (mean +/- SD) and median mean bloo d pressure, esophageal temperature, and end-tidal carbon dioxide level s were 63 mmHg, 36.8 degrees C, and 32 mmHg, respectively. The average serum inorganic fluoride concentration 2 h after anesthesia was 66.2 +/- 14.7 mu M. Results of tests of hepatic function and renal function (BUN, creatinine concentration) were unchanged after anesthesia. Gluc ose, protein, albumin, and NAG excretion were not significantly increa sed after anesthesia. Urine concentrations of cu-GST and pi-GST were i ncreased on day 1 after anesthesia and alpha-GST was increased on day 2 after anesthesia but returned to normal afterward. Conclusions: Prol onged (8 h), high concentration (3%) sevoflurane anesthesia administer ed to volunteers in a fresh gas flow of 2 l/min does not result in cli nically significant changes in biochemical markers of renal or hepatic dysfunction.