Renal function in patients during and after hypotensive anesthesia with sevoflurane.
OBJECTIVE
To evaluate renal function during and after hypotensive anesthesia with sevoflurane compared with isoflurane in the clinical setting.


METHODS
Randomized, prospective study.


METHODS
Inpatient surgery at Rosai Hospital.


METHODS
26 ASA physical status I and II patients scheduled for orthopedic surgery.


METHODS
Patients received isoflurane, nitrous oxide (N2O), and fentanyl (Group I = isoflurane group; n = 13) or sevoflurane, N2O, and fentanyl (Group S = sevoflurane group; n = 13). Controlled hypotension was induced with either isoflurane or sevoflurane to maintain mean arterial pressure at 60 mmHg for 120 minutes.


RESULTS
Measurements included serum inorganic fluoride (previously speculated to influence renal function), creatinine clearance (CCr; to assess renal glomerular function), urinary N-acetyl-beta-D-glucosaminidase (NAG; to assess renal tubular function), blood urea nitrogen (BUN), and serum creatinine (as clinical renal function indices). Serum fluoride, CCr, and NAG were measured before hypotension, 60 minutes, and 120 minutes after the start of hypotension, 30 minutes after recovery of normotension, and on the first postoperative day. BUN and serum creatinine were measured preoperatively and on the third and seventh postoperative days. Minimum alveolar concentration times hour was 3.6 +/- 1.8 in Group I and 4.0 +/- 0.7 in Group S. In both groups, BUN and serum creatinine did not change, and CCr significantly decreased after the start of hypotension. In Group I, serum fluoride and NAG did not change. In Group S, serum fluoride significantly increased after the start of hypotension compared with prehypotension values and compared with Group I values. In addition, NAG significantly increased at 120 minutes after the start of hypotension and at 30 minutes after recovery of normotension, but returned to prehypotension values on the first postoperative day.


CONCLUSIONS
Two hours of hypotensive anesthesia with sevoflurane under 5 L/min total gas flow in patients having no preoperative renal dysfunction transiently increased NAG, which is consistent with a temporary, reversible disturbance of renal tubular function.
Hara
T
T
Department of Anesthesiology, Nagasaki Rosai Hospital, Japan.
Fukusaki
M
M
Nakamura
T
T
Sumikawa
K
K
D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D001784:Blood Gas Analysis; D003404:Creatinine / Q000652:urine; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology; D006596:Hexosaminidases / Q000652:urine; D006801:Humans; D007023:Hypotension, Controlled; D007530:Isoflurane / Q000009:adverse effects; D007674:Kidney Diseases / Q000139:chemically induced* / Q000503:physiopathology*; D007677:Kidney Function Tests; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects; D008875:Middle Aged; D019637:Orthopedic Procedures; D011446:Prospective Studies; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D003404:Creatinine; D007530:Isoflurane; D006596:Hexosaminidases