The effect of ketorolac and sevoflurane anesthesia on renal glomerular andtubular function

We assessed the renal effects of the combination of ketorolac and sevoflura ne anesthesia by using sensitive and specific markers of renal proximal and distal tubular and glomerular function. Thirty women (ASA physical status I and H) undergoing breast surgery received either ketorolac 30 mg IM or sa line at premedication, at the end, and 6 h after anesthesia maintained with sevoflurane. Peak levels of serum fluoride at 2 h after the end of anesthe sia were 30.1 mu mol/L (21.0-50.0 mu mol/L) in the Ketorolac group and 33.3 mu mol/L (13.0-38.0 mu mol/L) in the Control group (mean and range, not si gnificant). Urine a,microglobulin indexed to urine creatinine was increased from 2 h after the start of anesthesia until the first postoperative day i n the Ketorolac group (peak level, 0.8 +/- 0.4 mg/mmol; upper limit of norm al, 0.7 mg/mmol) but did not change in the Control group. Urine glutathione -S-transferase (GST)-alpha indexed to urine creatinine (GST-alpha /creatini ne) and GST-pi /creatinine were increased 2 h after anesthesia and returned to baseline values thereafter in both groups. There were no changes in ser um cystatin C and urine kallikrein or urine output per hour between groups. The perioperative administration of ketorolac to healthy, well hydrated pa tients anesthetized with sevoflurane did not produce renal glomerular or tu bular dysfunction.