Sevoflurane has no adverse effects on renal function in cirrhotic patients: a comparison with propofol

Jc, Song; Mz, Zhang; Qc, Wu; Zj, Lu; Ym, Sun; Yang, Li‐Qun; Wf, Yu

doi:10.1111/aas.12085

Cited by 6 publications

(3 citation statements)

References 30 publications

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“…The results showed no significant changes in blood urea nitrogen levels, serum creatinine concentrations, or creatinine clearance after anesthesia within each group [10]. Even in cirrhotic patients who are prone to renal dysfunction after anesthesia, [11] concluded that sevoflurane did not seem to impair post-operative renal function. Also recently, Sahin and coworkers [12] evaluated the effect of moderate duration low-flow sevoflurane on renal and hepatic functions in 80 patients, with an operation time of 120-240 min.…”

Section: Discussionmentioning

confidence: 87%

Safety and consumption of sevoflurane versus desflurane using target controlled anesthesia in children

Ghobrial

Ghoneim

2014

Egyptian Journal of Anaesthesia

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Background: Recently a concept of target controlled inhalational anesthesia (TCA) is introduced in which the fresh gas flow and its composition are automatically delivered to the patients with the least possible flow. The aim of this study is to compare safety, consumption and cost of both sevoflurane and desflurane when delivered by target controlled anesthesia (TCA) using fully closed circuit conditions. Patient and method: After approval of the hospital review board and obtaining parental informed consent, 60 pediatric patients aged 2-12 were selected. The patients were classified into two groups according to the anesthetic used S Group (n = 30) in which sevoflurane D Group (n = 30): in which desflurane was used. Both were delivered by auto control mode of Zeus machine. Anesthetic agent and O 2 consumption, cost and number of adjustments were assessed. Blood samples were obtained preoperatively and at 24, 48 and 72 h after the end of surgery for measuring serum creatinine, BUN, AST and ALT. Twenty-four hour urine samples were collected for 3 consecutive days to measure glucose, microprotein and creatinine for the estimation of creatinine clearance. Results: This study revealed that sevoflurane group had a lower O 2 , anesthetic consumption and cost than desflurane group. Also both groups had higher levels of serum urea and creatinine together with urinary microproteins and glucose in the first three post-operative days compared to preoperative values which indicates minor tubular insult. However there was no statistically significant difference between the two groups. Conclusion: Sevoflurane is as safe as desflurane when delivered by auto control mode of Zeus machine with decreased anesthetic consumption and cost.

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Section: Discussionmentioning

confidence: 87%

Safety and consumption of sevoflurane versus desflurane using target controlled anesthesia in children

Ghobrial

Ghoneim

2014

Egyptian Journal of Anaesthesia

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“…Of these 186 RCTs, a further 131 articles were excluded from quantitative synthesis (125 articles were excluded as they did not measure renal parameters as a part of their outcomes and six articles were excluded as we could not retrieve the full texts despite multiple attempts). [15][16][17][18][19][20] Twelve other studies were also excluded [21][22][23][24][25][26][27][28][29][30][31][32] (Fig. 1; PRISMA diagram) and data were extracted from 41 RCTs.…”

Section: Resultsmentioning

confidence: 99%

The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials

Sondekoppam

Narsingani

Schimmel

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Renal damage secondary to fluoride ions and compound A (CpdA) after sevoflurane anesthesia remains unclear. For safety reasons, some countries still recommend minimum fresh-gas flows (FGFs) with sevoflurane. We review the evidence regarding the intraoperative use of sevoflurane for anesthesia maintenance and postoperative renal function compared with other anesthetic agents used for anesthetic maintenance. Secondarily, we examine the effects of peak plasma fluoride and CpdA levels and the effect of FGF and duration of anesthesia on these parameters. Source The databases of MEDLINE (OVID and Pubmed), EMBASE, the Cochrane Library, Health Technology Assessment Database, CINAHL, and Web of Science were searched from inception until 23 April 2020 to identify randomized-controlled trials (RCTs) in humans utilizing sevoflurane or an alternative anesthetic for anesthesia maintenance with subsequent measurements of renal function. Two different paired reviewers independently selected the studies and extracted data. The quality of the evidence was appraised using GRADE recommendations. Principal findings Of 3,766 publications screened, 41 RCTs in human patients were identified. There was no difference between creatinine at 24 hr (21 studies; n = 1,529), or creatinine clearance (CCR) at 24 hr (12 studies; n = 728) in the sevoflurane vs alternative anesthetic groups. Peak fluoride and fluoride measured at 24 hr were higher with sevoflurane compared with other inhaled anesthetics. Subgroup analyses for sevoflurane usage in various contexts showed no significant difference between sevoflurane and alternative anesthetics for creatinine or CCR at 24 hr at varying FGF, duration of exposure, baseline renal function, or absorbent use. Conclusions We did not find any association between the use of sevoflurane and postoperative renal impairment compared with other agents used for anesthesia maintenance. The scientific basis for recommending higher FGF with the use of sevoflurane needs to be revisited.

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“…In a recent randomized controlled trial, Song et al found no difference in postoperative renal function in cirrhotic patients who underwent liver resection randomized to receive sevoflurane or propofol as the principal anesthetic. 14 In sum, Yoo et al 10 conducted an elegant trial with a well-founded physiologic background and careful experimental design that allowed control of confounding variables and feasibility of replication in larger patient populations. While the results are provocative, limitations include the small sample size and a relatively healthy population that may not be generalizable to the entire cardiac surgery patient population.…”

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confidence: 99%

Propofol as a panacea for acute kidney injury?

Huddleston

Liu

2014

Kidney International

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Yoo and colleagues report a small but provocative randomized clinical trial to prevent acute kidney injury in the setting of cardiopulmonary bypass surgery. Their article describes a trial of 112 patients undergoing valvular surgery with cardiopulmonary bypass who were randomized to receive sevoflurane (an inhaled anesthetic) or propofol for general anesthesia. The use of propofol was associated with a significant decrease in the rate of postoperative acute kidney injury.

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Sevoflurane has no adverse effects on renal function in cirrhotic patients: a comparison with propofol

Abstract: Sevoflurane does not seem to impair post-operative renal function in cirrhotic patients undergoing liver resection.

Cited by 6 publications

References 30 publications

Safety and consumption of sevoflurane versus desflurane using target controlled anesthesia in children

Safety and consumption of sevoflurane versus desflurane using target controlled anesthesia in children

The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials

Propofol as a panacea for acute kidney injury?

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