The Effects of Sevoflurane and Isoflurane Anesthesia on Renal Tubular Function in Patients with Moderately Impaired Renal Function

Abstract

Increasing evidence indicates that sevoflurane anesthesia does not impair renal function in healthy patients despite higher concentrations of plasma inorganic fluoride. However, whether sevoflurane further affects renal tubular function in patients with impaired renal function is not known. We compared the effect of sevoflurane anesthesia with that of isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function. Fourteen patients with creatinine clearance between 10 and 55 mL/min were anesthetized with either sevoflurane or isoflurane using a semiclosed circuit system. Plasma inorganic fluoride concentrations and urine N-acetyl-beta-D-glucosaminidase (NAG), gamma-glutamyltranspeptidase (gamma-GTP), and beta 2-microglobulin (beta 2MG) excretions were measured up to post-anesthetic day 14. Although both the peak plasma inorganic fluoride concentrations and the areas under the curve of plasma inorganic fluoride concentration versus time were significantly greater in the sevoflurane group than in the isoflurane group, urine NAG, gamma-GTP, and beta 2MG excretions per day did not differ between the two groups. These results indicate that sevoflurane and isoflurane may have similar effects on the renal tubules in patients with moderately impaired renal function.

Effects of cigarette smoking on serum fluoride concentrations and renal function integrity after 1 MAC‐h sevoflurane anaesthesia

“…In two previous studies evaluating the effect of sevoflurane inhalation on tubular function, the results have been inconclusive. In patients with moderately impaired renal function, U‐β 2 ‐microglobulin did not increase during 5 MAC‐h sevoflurane anaesthesia (19), but, in another study, U‐β 2 ‐microglobulin increased in patients after 11 MAC‐h sevoflurane anaesthesia (20).…”

Sevoflurane and renal function: a meta-analysis of randomized trials

“…However, even in patients with renal insufficiency (creatinine ≥ 1.5 mg/dL), low flow sevoflurane is shown to be safe. 2 4 19 Low-flow sevoflurane is as safe as low-flow isoflurane and does not alter renal function in patients with preexisting renal disease. These results amplify previous studies in patients with renal insufficiency conducted at higher flow rates which showed no significant differences in the renal effects of sevoflurane and other volatile anesthetics.…”

Sevoflurane: Approaching the Ideal Inhalational Anesthetic A Pharmacologic, Pharmacoeconomic, and Clinical Review

“…However, 3 patients anesthetized with sevoflurane and 4 with enflurane experienced a transient increase in serum creatinine of at least 20%. In another study, sevoflurane (n = 7) was compared with isoflurane (n = 7) in patients with moderately impaired renal function observed (310). No postoperative differences in BUN, plasma creatinine, or in urinary excretion of NAG, 2-microglobulin, or g-glutamyltranspeptidase were observed.…”