Uptake and biotransformation of sevof lurane in humans: A comparative study of sevof lurane with halothane, enflurane, and isoflurane

Shiraishi, Yoshito; Ikeda, Kazuyuki

doi:10.1016/0952-8180(90)90024-w

Cited by 90 publications

(46 citation statements)

References 10 publications

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“…The 3 most commonly used inhaled anesthetics-isoflurane, sevoflurane, and desflurane-undergo very little in vivo metabolism in clinical use. 2 Less than 5% of these volatile anesthetics is metabolized by the patient. 3 Because they undergo very little metabolic change inside the body, upon exhalation by the patient these agents remain in a form that may pollute the environment.…”

Section: Anesthetic Agentsmentioning

confidence: 99%

Environmental Implications of Anesthetic Gases

Yasny

White²

2012

Anesthesia Progress

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For several decades, anesthetic gases have greatly enhanced the comfort and outcome for patients during surgery. The benefits of these agents have heavily outweighed the risks. In recent years, the attention towards their overall contribution to global climate change and the environment has increased. Anesthesia providers have a responsibility to minimize unnecessary atmospheric pollution by utilizing techniques that can lessen any adverse effects of these gases on the environment. Moreover, health care facilities that use anesthetic gases are accountable for ensuring that all anesthesia equipment, including the scavenging system, is effective and routinely maintained. Implementing preventive practices and simple strategies can promote the safest and most healthy environment.

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Section: Anesthetic Agentsmentioning

confidence: 99%

Environmental Implications of Anesthetic Gases

Yasny

White²

2012

Anesthesia Progress

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“…However, isoflurane (94.4%) and halothane (91.5%) usage were very high as noted in other studies [45]. Halothane, however, is reported to be rarely used in the united states currently [46].…”

Section: Discussionmentioning

confidence: 68%

Knowledge of Anaesthesia Providers on Exposure to Inhalational Anaesthetic Agents in Ghana

Darkwa¹,

Djagbletey²,

Ofosu-Appiah³

et al. 2017

JBM

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Background: Chronic exposure to inhaled anaesthetic agents poses an occupational hazard related to the practice of anaesthesia. Therefore, this study sought to find out the perception of anaesthesia providers on exposure to inhalational anaesthetics, evaluate their knowledge on the effects of chronic exposure and strategies to reduce chronic exposure to operating room inhalational anaesthetic agents. Method: This cross-sectional survey was conducted by administering a self-administered questionnaire to 71 anaesthesia providers in Ghana who attended the annual refresher course of the faculty of Anaesthesia, West African College of Surgeons, in 2016. Data collected were analysed and presented as frequencies and percentages. Results: Halothane and isoflurane were the most frequently used inhalational agents by the respondents. Majority (90.1%) of the respondents perceived they are exposed to inhalational anaesthetics in their working environment. Majority of the anaesthetic providers cited poorly functioning scavenging systems (28.2%) and use of paediatric Ayre's T-piece (28.2%) as sources of exposure to inhalational anaesthetics. All respondents admitted making attempts to reduce their exposure to inhalational anaesthetics. Majority of the respondents mentioned teratogenicity (77.5%) and hepatotoxicity (67.6%) as effects of chronic exposure to inhaled anaesthetic agents. Conclusion: Anaesthesia providers in Ghana perceived they are chronically exposed to inhalational anaesthetic agents in their work environment. They are aware of the sources of inhalational anaesthetic agent exposure, associated health risks and strategies required to reduce chronic exposure to inhaled anaesthetic agents.

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“…Isoflurane was chosen as a control drug as it undergoes little biotransformation [3]. The effects of surgery and blood loss on hepatic and renal function were minimised by studying patients undergoing body surface surgery.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

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confidence: 99%

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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Uptake and biotransformation of sevof lurane in humans: A comparative study of sevof lurane with halothane, enflurane, and isoflurane

Cited by 90 publications

References 10 publications

Environmental Implications of Anesthetic Gases

Environmental Implications of Anesthetic Gases

Knowledge of Anaesthesia Providers on Exposure to Inhalational Anaesthetic Agents in Ghana

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

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