title: Comparison of renal function following anesthesia with low-flow sevoflurane and isoflurane.
abstract: OBJECTIVE
  To evaluate postoperative renal function after patients were administered sevoflurane under conditions designed to generate high concentrations of compound A.
  
  
  METHODS
  A multicenter (11 sites), multinational, open-label, randomized, comparative study of perioperative renal function in patients who have received low-flow (< or = 1 L/min) sevoflurane or isoflurane.
  
  
  METHODS
  254 ASA physical status I, II and III patients requiring endotracheal intubation for elective surgery lasting more than 2 hours.
  
  
  METHODS
  After induction, low-flow anesthesia was initiated at a flow rate < or = 1 L/min. Blood and urine samples were studied to assess postoperative renal function.
  
  
  RESULTS
  Measurements of serum BUN and creatinine, and urine glucose, protein, pH, and specific gravity were used to assess renal function preoperatively and up to 3 days postoperatively. Serum inorganic fluoride ion concentration was measured at preinduction, emergence, and 2, 24 and 72 hours postoperatively. Compound A concentrations were measured at two sites for those patients receiving sevoflurane. Adverse experience data were analyzed. One hundred eighty-eight patients were considered evaluable (98 sevoflurane and 90 isoflurane). Peak serum fluoride concentrations were significantly higher after sevoflurane (40 +/- 16 microM) than after isoflurane (3 +/- 2 microM). Serum creatinine and BUN decreased in both groups postoperatively; glucosuria and proteinuria occurred in 15% to 25% of patients. There were no clinically significant differences in BUN, creatinine, glucosuria, and proteinuria between the low-flow sevoflurane and low-flow isoflurane patients.
  
  
  CONCLUSIONS
  There were no statistically significant differences in the renal effects of sevoflurane or isoflurane in surgical patients undergoing low-flow anesthesia for up to 8 hours. Low-flow sevoflurane anesthesia under clinical conditions expected to produce high levels of compound A appears as safe as low-flow isoflurane anesthesia.
authors.affiliation: Department of Anesthesiology, Albany Medical College, NY 12208, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Groudine
authors.forename: R J
authors.initials: RJ
authors.lastname: Fragen
authors.forename: E D
authors.initials: ED
authors.lastname: Kharasch
authors.forename: T S
authors.initials: TS
authors.lastname: Eisenman
authors.forename: E J
authors.initials: EJ
authors.lastname: Frink
authors.forename: S
authors.initials: S
authors.lastname: McConnell
mesh_terms: D019162:Anesthetics, Combined; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane; D007677:Kidney Function Tests; D008738:Methyl Ethers; D011182:Postoperative Care; D012212:Rheology; D000077149:Sevoflurane
chemical_list: D019162:Anesthetics, Combined; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane