Nephrotoxicity of Sevoflurane Versus Desflurane Anesthesia in Volunteers
| Autor: | Richard B. Weiskopf, Michael J. Laster, Edmond I. Eger, James M. Sonner, Terri Bowland, Pompiliu Ionescu, Diane Gong, Zexu Fang, Donald D. Koblin |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Methyl Ethers Hydrocarbons Fluorinated Renal function Kidney Kidney Function Tests Sevoflurane Blood Urea Nitrogen Nephrotoxicity Fluorides chemistry.chemical_compound Desflurane Glycosuria medicine Albuminuria Humans Blood urea nitrogen Volunteer Glutathione Transferase Creatinine Isoflurane business.industry Anesthesiology and Pain Medicine Liver chemistry Anesthesia Anesthetics Inhalation Anesthetic Anesthesia Inhalation business Ethers medicine.drug |
| Zdroj: | Anesthesia & Analgesia. 84:160-168 |
| ISSN: | 0003-2999 |
| DOI: | 10.1097/00000539-199701000-00029 |
| Popis: | Present package labeling for sevoflurane recommends the use of fresh gas flow rates of 2 L/min or more when delivering anesthesia with sevoflurane. This recommendation resulted from a concern about the potential nephrotoxicity of a degradation product of sevoflurane, "Compound A," produced by the action of carbon dioxide absorbents on sevoflurane. To assess the adequacy of this recommendation, we compared the nephrotoxicity of 8 h of 1.25 minimum alveolar anesthetic concentration (MAC) sevoflurane (n = 10) versus desflurane (n = 9) in fluid-restricted (i.e., nothing by mouth overnight) volunteers when the anesthetic was given in a standard circle absorber anesthetic system at 2 L/min. Subjects were tested for markers of renal injury (urinary albumin, glucose, alpha-glutathione-S-transferase [GST], and pi-GST; and serum creatinine and blood urea nitrogen [BUN]) before and 1, 2, 3, and/or 5-7 days after anesthesia. Desflurane did not produce renal injury. Rebreathing of sevoflurane produced average inspired concentrations of Compound A of 41 +/- 3 ppm (mean +/- SD). Sevoflurane was associated with transient injury to: 1) the glomerulus, as revealed by postanesthetic albuminuria; 2) the proximal tubule, as revealed by postanesthetic glucosuria and increased urinary alpha-GST; and 3) the distal tubule, as revealed by postanesthetic increased urinary pi-GST. These effects varied greatly (e.g., on postanesthesia Day 3, the 24-h albumin excretion was < 0.03 g (normal) for one volunteer; 0.03-1 g for five others; 1-2 g for two others; 2.1 g for one volunteer; and 4.4 g for another volunteer). Neither anesthetic affected serum creatinine or BUN, nor changed the ability of the kidney to concentrate urine in response to vasopressin, 5 U/70 kg subcutaneously (i.e., these measures failed to reveal the injury produced). In addition, sevoflurane, but not desflurane, caused small postanesthetic increases in serum alanine aminotransferase (ALT), suggesting mild, transient hepatic injury. |
| Databáze: | OpenAIRE |
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