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

Tsukamoto, Noboru; Hirabayashi, Yoshihiro; Shimizu, R; Mitsuhata, H

doi:10.1213/00000539-199605000-00003

Cited by 4 publications

(4 citation statements)

References 18 publications

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“…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.…”

Section: Renal Effectsmentioning

confidence: 97%

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

2001

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Sevoflurane is a safe and versatile inhalational anesthetic compared with currently available agents. Sevoflurane is useful in adults and children for both induction and maintenance of anesthesia in inpatient and outpatient surgery. Of all currently used anesthetics, the physical, pharmacodynamic, and pharmacokinetic properties of sevoflurane come closest to that of the ideal anesthetic (200). These characteristics include inherent stability, low flammability, non-pungent odor, lack of irritation to airway passages, low blood:gas solubility allowing rapid induction of and emergence from anesthesia, minimal cardiovascular and respiratory side effects, minimal end-organ effects, minimal effect on cerebral blood flow, low reactivity with other drugs, and a vapor pressure and boiling point that enables delivery using standard vaporization techniques. As a result, sevoflurane has become one of the most widely used agents in its class.

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Section: Renal Effectsmentioning

confidence: 97%

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

2001

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“…[64] When compared with isoflurane, sevoflurane produced similar changes in markers of renal function in patients with moderate kidney dysfunction. [65] …”

Section: Renal Effectsmentioning

confidence: 99%

Sevoflurane in Paediatric Anaesthesia

Goa¹,

Noble²,

Spencer³

1999

Pediatric Drugs

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Sevoflurane is a preferred anaesthetic agent for induction and maintenance of paediatric anaesthesia because of its rapid induction and recovery characteristics, lack of pungency and agreeable odour, and acceptable cardiovascular profile. Although the issue of postoperative excitement requires clarification, sevoflurane anaesthesia can be considered a rational choice for ambulatory and nonambulatory surgery in children.

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“…No evidence of impaired renal concentrating ability has been demonstrated with sevoflurane [7], although an increase in urinary N-acetyl-bglucosaminidase (NAG) has been noted in patients undergoing prolonged anaesthesia in conjunction with antibiotic therapy [8]. Other work using NAG has shown a similar effect on renal tubules to that of isoflurane [9]. In this study, serum fluoride concentrations were monitored and serum osmolality and creatinine clearance used as measures of renal function.…”

Section: Discussionmentioning

confidence: 94%

Serum glutathione S‐transferase concentrations and creatinine clearance after sevoflurane anaesthesia

et al. 1997

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SummaryThe effects of sevoflurane and isoflurane on serum glutathione S-transferase concentrations and creatinine clearance were compared in 50 ASA I-III patients aged over 18 years undergoing body surface surgery of 1-3 h predicted duration. Patients randomly received sevoflurane (n ¼ 24) or isoflurane (n ¼ 26) in nitrous oxide and oxygen (FIO 2 ¼ 0.4) via a nonrebreathing system. Fluids were standardised and patient's lungs ventilated to normocapnia. Expired concentration of anaesthetic agent was adjusted to maintain systolic arterial pressure between 70 and 100% of baseline. Patients received significantly less (p < 0.05) sevoflurane (1.0 MAC-h) than isoflurane (1.5 MAC-h). Using serum glutathione S-transferase concentrations and creatinine clearance as markers of hepatic and renal function respectively, no statistically significant differences were identified between the groups. Although sevoflurane has been administered to over one million patients in Japan and undergone extensive clinical trials in Europe and North America, concerns remain about its potential for organ toxicity [1,2]. A rate of metabolism which is greater than isoflurane or enflurane [3] may increase the risk of hepatotoxicity. Serum glutathione S-transferase (GST) concentration was used in this study as a specific marker of hepatocellular injury owing to its location in centrilobular hepatocytes and a short serum half-life [4,5].Sevoflurane is metabolised to inorganic fluoride which has been associated with nephrotoxicity in patients receiving methoxyflurane [6]. No evidence of impaired renal concentrating ability has been demonstrated with sevoflurane [7], although an increase in urinary N-acetyl-bglucosaminidase (NAG) has been noted in patients undergoing prolonged anaesthesia in conjunction with antibiotic therapy [8]. Other work using NAG has shown a similar effect on renal tubules to that of isoflurane [9]. In this study, serum fluoride concentrations were monitored and serum osmolality and creatinine clearance used as measures of renal function. MethodsWith University Ethics Committee approval and written informed consent, 50 ASA I-III patients were admitted to the study. All were in-patients over 18 years undergoing body surface surgery of 1-3 h predicted duration. Patients with evidence of hepatic or renal dysfunction or a history of heavy alcohol intake (>21 units.week ¹1 for men or >14 units.week ¹1 for women) were excluded. Patients receiving any drugs known to induce hepatic enzymes or who had received general anaesthesia within the previous week were also excluded and all women were tested to exclude pregnancy.Venous blood was drawn for baseline tests of hepatic function including aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP) activities and serum GST concentration. Serum electrolytes, urea, fluoride, creatinine and osmolality were also measured. A urine sample was obtained for the measurement of urine osmolality and a timed urine collection was started on adm...

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

Cited by 4 publications

References 18 publications

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

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

Sevoflurane in Paediatric Anaesthesia

Serum glutathione S‐transferase concentrations and creatinine clearance after sevoflurane anaesthesia

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