Low-flow sevoflurane compared with low-flow isoflurane anesthesia in patients with stable renal insufficiency.

BACKGROUND Sevoflurane is degraded to compound A (CpA) by carbon dioxide absorbents containing strong base. CpA is nephrotoxic in rats. Patient exposure to CpA is increased with low fresh gas flow rates, use of Baralyme, and high sevoflurane concentrations. CpA formation during low-flow and closed circuit sevoflurane anesthesia had no significant renal effects in surgical patients with normal renal function. Preexisting renal insufficiency is a risk factor for postoperative renal dysfunction. Although preexisting renal insufficiency is not affected by high-flow sevoflurane, the effect of low-flow sevoflurane in patients with renal insufficiency is unknown. METHODS After obtaining institutional review board approval, 116 patients with a stable preoperative serum creatinine concentration 1.5 mg/dl or greater were assessable. Patients were randomized to receive either sevoflurane (n = 59, 0.8-2.5 vol%) or isoflurane (n = 57, 0.5-1.4 vol%) at a fresh gas flow rate of 1 l/min or less. Use of opioids was restricted to a minimum, and Baralyme was used to increase CpA exposure. Inspiratory and expiratory CpA concentrations were measured during anesthesia. Renal function (serum creatinine and blood urea nitrogen, urine protein and glucose, creatinine clearance) was measured preoperatively and 24 and 72 h after induction. RESULTS Demographic patient data did not differ between groups. Patients received 3.1 +/- 2.4 minimum alveolar concentration-hours sevoflurane or 3.8 +/- 2.6 minimum alveolar concentration-hours isoflurane (mean +/- SD). Durations of low flow were 201.3 +/- 98.0 and 213.6 +/- 83.4 min, respectively. Maximum inspiratory CpA with sevoflurane was 18.9 +/- 7.6 ppm (mean +/- SD), resulting in an average total CpA exposure of 44.0 +/- 30.6 ppm/h. There were no statistically significant changes from baseline to 24- and 72-h values for serum creatinine or blood urea nitrogen, creatinine clearance, urine protein, and glucose, nor were there significant differences between both anesthetics. CONCLUSION There were no statistically significant differences in measured parameters of renal function after low-flow sevoflurane anesthesia compared with isoflurane. These results suggest that low-flow sevoflurane anesthesia is as safe as low-flow isoflurane and does not alter kidney function in patients with preexisting renal disease.

[1]  Y. Adachi,et al.  The Effects of Low-Flow Sevoflurane and Isoflurane Anesthesia on Renal Function in Patients with Stable Moderate Renal Insufficiency , 2001, Anesthesia and analgesia.

[2]  T. Ebert,et al.  Renal Responses to Low-flow Desflurane, Sevoflurane, and Propofol in Patients , 2000, Anesthesiology.

[3]  H. Ives,et al.  The renal safety of sevoflurane. , 2000, Anesthesia and analgesia.

[4]  R. Mazze,et al.  The Effects of Sevoflurane on Serum Creatinine and Blood Urea Nitrogen Concentrations: A Retrospective, Twenty-Two–Center, Comparative Evaluation of Renal Function in Adult Surgical Patients , 2000, Anesthesia and analgesia.

[5]  E. Kharasch,et al.  Compound A uptake and metabolism to mercapturic acids and 3,3,3-trifluoro-2-fluoromethoxypropanoic acid during low-flow sevoflurane anesthesia: biomarkers for exposure, risk assessment, and interspecies comparison. , 1999, Anesthesiology.

[6]  T. Eisenman,et al.  Comparison of renal function following anesthesia with low-flow sevoflurane and isoflurane. , 1999, Journal of clinical anesthesia.

[7]  A. DeBree,et al.  A Multicenter Study Evaluating the Effects of Sevoflurane on Renal Function in Patients With Renal Insufficiency , 1998, Journal of cardiovascular pharmacology and therapeutics.

[8]  H. Higuchi,et al.  Effects of Sevoflurane and Isoflurane on Renal Function and on Possible Markers of Nephrotoxicity , 1998, Anesthesiology.

[9]  E. Kharasch,et al.  Assessment of Low-Flow Sevoflurane and Isoflurane Effects on Renal Function Using Sensitive Markers of Tubular Toxicity , 1998 .

[10]  T. Ebert,et al.  Absence of Renal and Hepatic Toxicity After Four Hours of 1.25 Minimum Alveolar Anesthetic Concentration Sevoflurane Anesthesia in Volunteers , 1998, Anesthesia and analgesia.

[11]  E. Kharasch,et al.  Absence of Biochemical Evidence for Renal and Hepatic Dysfunction after 8 Hours of 1.25 Minimum Alveolar Concentration Sevoflurane Anesthesia in Volunteers , 1998, Anesthesiology.

[12]  R. Jamison,et al.  Low-flow (1 l/min) sevoflurane: is it safe? , 1997, Anesthesiology.

[13]  K. Ikeda,et al.  Effects of Low‐flow Sevoflurane Anesthesia on Renal Function: Comparison with High‐flow Sevoflurane Anesthesia and Low‐flow Isoflurane Anesthesia , 1997, Anesthesiology.

[14]  K. Miyasaka,et al.  [Repeated low-flow sevoflurane anesthesia: effects on hepatic and renal function in beagles]. , 1997, Masui. The Japanese journal of anesthesiology.

[15]  G. A. Rooke,et al.  The Hemodynamic and Renal Effects of Sevoflurane and Isoflurane in Patients with Coronary Artery Disease and Chronic Hypertension , 1996, Anesthesia and analgesia.

[16]  Y. Hirabayashi,et al.  The Effects of Sevoflurane and Isoflurane Anesthesia on Renal Tubular Function in Patients with Moderately Impaired Renal Function , 1996, Anesthesia and analgesia.

[17]  K. Ikeda,et al.  Renal and Hepatic Function in Surgical Patients After Low-Flow Sevoflurane or Isoflurane Anesthesia , 1996, Anesthesia and analgesia.

[18]  J. Hobbhahn,et al.  [Serum fluoride concentrations and exocrine kidney function with sevoflurane and enflurane. An open, randomized, comparative phase III study of patients with healthy kidneys]. , 1996, Der Anaesthesist.

[19]  P. Prokocimer,et al.  Inhalation Toxicity Study of a Haloalkene Degradant of Sevoflurane, Compound A (PIFE), in Sprague‐Dawley Rats , 1995, Anesthesiology.

[20]  K. Peter,et al.  Renal Function and Serum Fluoride Concentrations in Patients with Stable Renal Insufficiency After Anesthesia with Sevoflurane or Enflurane , 1995, Anesthesia and analgesia.

[21]  H. Higuchi,et al.  Renal Function in Patients with High Serum Fluoride Concentrations after Prolonged Sevoflurane Anesthesia , 1995, Anesthesiology.

[22]  D. Cunningham,et al.  Analysis of sevoflurane degradation products in vapor phase samples. , 1995, Journal of chromatography. B, Biomedical applications.

[23]  K. Ikeda,et al.  Effect of total flow rate on the concentration of degradation products generated by reaction between sevoflurane and soda lime. , 1995, British Journal of Anaesthesia.

[24]  E. Kharasch,et al.  Human Kidney Methoxyflurane and Sevoflurane Metabolism: Intrarenal Fluoride Production as a Possible Mechanism of Methoxyflurane Nephrotoxicity , 1994, Anesthesiology.

[25]  T. Nishiyama,et al.  [Effects of inorganic fluoride, inhalation time and dosage of sevoflurane on renal function during sevoflurane anesthesia of long duration]. , 1994, Masui. The Japanese journal of anesthesiology.

[26]  K. Ikeda,et al.  Plasma Inorganic Fluoride and Intracircuit Degradation Product Concentrations in Long‐Duration, Low‐Flow Sevoflurane Anesthesia , 1994, Anesthesia and analgesia.

[27]  K. Ikeda,et al.  Long‐duration, Low‐flow Sevoflurane Anesthesia Using Two Carbon Dioxide Absorbents: Quantification of Degradation Products in the Circuit , 1994, Anesthesiology.

[28]  S. Morgan,et al.  Renal Concentrating Function with Prolonged Sevoflurane or Enflurane Anesthesia in Volunteers , 1994, Anesthesiology.

[29]  E. Eger,et al.  Toxicity of Compound A in Rats: Effect of a 3‐Hour Administration , 1994, Anesthesiology.

[30]  R. Thisted,et al.  Association of Preoperative Risk Factors with Postoperative Acute Renal Failure , 1994, Anesthesia and analgesia.

[31]  K. Ikeda,et al.  Closed‐circuit Anesthesia with Sevoflurane in Humans Effects on Renal and Hepatic Function and Concentrations of Breakdown Products with Soda Lime in the Circuit , 1994, Anesthesiology.

[32]  S. Morgan,et al.  Plasma inorganic fluoride levels with sevoflurane anesthesia in morbidly obese and nonobese patients. , 1993 .

[33]  S. Morgan,et al.  Plasma Inorganic Fluoride Levels with Sevoflurane Anesthesia in Morbidly Obese and Nonobese Patients , 1993, Anesthesia and analgesia.

[34]  J. Takeda,et al.  Serum and Urinary Inorganic Fluoride Concentrations After Prolonged Inhalation of Sevoflurane in Humans , 1992, Anesthesia and analgesia.

[35]  A. J. Gandolfi,et al.  Plasma inorganic fluoride with sevoflurane anesthesia: correlation with indices of hepatic and renal function. , 1992 .

[36]  S. Morgan,et al.  Plasma Inorganic Fluoride With Sevoflurane Anesthesia: Correlation With Indices of Hepatic and Renal Function , 1992, Anesthesia and analgesia.

[37]  J. Gold,et al.  Postoperative Changes in Serum Creatinine: When Do They Occur and How Much Is Important? , 1989, Annals of surgery.

[38]  Jordan J. Cohen,et al.  Hospital-Acquired Renal Insufficiency: A Prospective Study , 1983 .

[39]  Cockcroft Dw,et al.  Prediction of Creatinine Clearance from Serum Creatinine , 1976 .

[40]  Ruddle Fh,et al.  Human gene mapping 3. Baltimore Conference (1975). Third International Workshop on Human Gene Mapping. Report of the committee on the genetic constitution of autosomes other than chromosomes 1, 2, and 6. , 1976, Cytogenetics and cell genetics.