Changes in plasma creatinine concentration after cardiac anesthesia with isoflurane, propofol, or sevoflurane - A randomized clinical trial

Background: Renal impairment often follows cardiac surgery. The authors inv estigated whether sevoflurane produces greater increases in plasma creatini ne concentration than isoflurane or propofol after elective coronary, arter y surgery. Methods: As part of maintenance anesthesia, including during cardiopulmonar y bypass, patients were randomly allocated to receive one of three agents: isoflurane (n = 118), sevoflurane (n = 118), or propofol (n = 118). Fresh g as flows were 3 l/min. The preoperative plasma creatinine concentration was subtracted from the highest creatinine concentration in the first 3 postop erative days. A median maximum increase greater than 44 muM (0.5 mg/dl) was regarded as clinically important. Data were analyzed on an intention-to-tr eat basis. Subgroup analyses were performed on per-protocol patients and th ose with preoperative renal impairment (creatinine concentration > 130 muM [1.47 mg/dl] or urea > 7.7 mM [blood urea nitrogen, 21.6 mg/dl]). Results: The differences between the groups were small, clinically unimport ant, and not statistically significant for the primary analysis and subgrou ps. The proportions of patients with creatinine Increases greater than 44 p m were 15% in the isoflurane group, 17% in the sevoflurane group, and 11% i n the propofol group (P = 0.45). The median increases were 8 muM in the iso flurane group, 4 muM in the sevoflurane group, and 6 muM in the propofol gr oup. The differences between the three median maximum increases were 1-4 mu M (P > 0.45). In the subgroup with preoperative renal impairment, the media n increases were 10 muM in the isoflurane group, 15 muM in the sevofluranc group, and 5 muM in the propofol group (P = 0.72). Conclusions: Sevoflurane did not produce greater increases in creatinine th an isoflurane or propofol after elective coronary artery surgery.