ASSESSMENT OF LOW-FLOW SEVOFLURANE AND ISOFLURANE EFFECTS ON RENAL-FUNCTION USING SENSITIVE MARKERS OF TUBULAR TOXICITY

Citation
Ed. Kharasch et al., ASSESSMENT OF LOW-FLOW SEVOFLURANE AND ISOFLURANE EFFECTS ON RENAL-FUNCTION USING SENSITIVE MARKERS OF TUBULAR TOXICITY, Anesthesiology, 86(6), 1997, pp. 1238-1253
Citations number
57
Categorie Soggetti
Anesthesiology
Journal title
ISSN journal
00033022
Volume
86
Issue
6
Year of publication
1997
Pages
1238 - 1253
Database
ISI
SICI code
0003-3022(1997)86:6<1238:AOLSAI>2.0.ZU;2-J
Abstract
Background: Carbon dioxide absorbents degrade sevoflurane, particularl y at low gas flow rates, to fluoromethyl-2,2-difluoro-1-(trifluorometh yl)vinyl ether (compound A). Compound A causes renal proximal tubular injury in rats but has had no effect on blood urea nitrogen (BUN) or c reatinine concentrations in patients, This investigation compared the effects of low-flow sevoflurane and isoflurane on renal tubular functi on in surgical patients using conventional (BUN and creatinine) and fi ner indices of renal injury, specifically those biomarkers sensitive f or compound A toxicity in rats (glucosuria, proteinuria, and enzymuria [N-acetyl-beta-D-glucosaminidase (NAG) and alpha-glutathione-S-transfe rase (alpha GST)]). Methods: Consenting patients with normal preoperat ive renal function at two institutions were randomized to receive sevo flurane (n = 36) or isoflurane (n = 37) in oxygen and air. Total gas n ow was 1 l/min, opioid doses were minimized, and barlum hydroxide lime was used to maximize anesthetic degradation Inspiratory and expirator y compound A concentrations were quantified every 30-60 min, Blood and urine were obtained before and 24-72 h after anesthesia for laborator y evaluation. Results: Sevoflurane and isoflurane groups were similar with respect to age, weight, sex, American Society of Anesthesiologist s status, anesthetic duration (3.7 or 3.9 h), and anesthetic exposure (3.6 or 3 minimum alveolar concentration [MAC-hour). Maximum inspired compound A concentration (mean +/- standard deviation) was 27 +/- 13 p pm (range, 10-67 ppm). Areas under the inspired and expired compound A concentration versus time curves (AUC) were 79 +/- 54-ppm-h (range, 1 0-223]ppm-h) and 53 +/- 40 ppm-h (range, 6-159 ppm-h), respectively. T here was no significant difference between anesthetic groups in postop erative serum creatinine or BUN, or urinary excretion of protein, gluc ose, NAG, proximal tubular alpha GST, or distal tubular pi GST. There was no significant correlation between compound A exposure (AUC) and p rotein, glucose, NAG, alpha GST, or pi GST excretion. Postoperative al anine and aspartate aminotransferase concentrations were nor different between the anesthetic groups, and there were no significant correlat ions between compound A exposure and alanine or aspartate aminotransfe rase concentrations. Conclusions: The renal tubular and hepatic effect s of low-flow sevoflurane and isoflurane were similar as assessed usin g both conventional measures of hepatic and renal function and more se nsitive biochemical markers of renal tubular cell necrosis, Moderate d uration low-flow sevoflurane anesthesia, during which compound A forma tion occurs, appears to be as safe as low-flow isoflurane anesthesia.