title: Comparison of the renal safety between carbon dioxide absorbent products under sevoflurane anesthesia: a pilot study.
abstract: BACKGROUND
  The chemical reaction of carbon dioxide absorbent and sevoflurane is known to produce compound A. However, carbon dioxide absorbents are not controlled by the Food and Drug Administration, but are treated as industrial products in some nations. Moreover, carbon dioxide absorbents differ in their capacities to produce compound A, because their chemical compositions differ. In this study, we compared the renal safety between carbon dioxide absorbent products in patients under sevoflurane anesthesia.
  
  
  METHODS
  Eighty patients with no preexisting renal disease undergoing elective gynecologic surgery were randomly assigned to receive sevoflurane or isoflurane anesthesia with one of four carbon dioxide absorbent products (Sodasorblime®, Sodalyme®, Sodasorb®, Spherasorb®) at the same fresh gas flow of 2 L/min. The renal safety was evaluated by changes of blood urea nitrogen (BUN), creatinine and urine N-acetyl-b-glucoseaminidase (NAG)-creatinine ratio at 24 hours and 72 hours after surgery from preoperative level.
  
  
  RESULTS
  There was no significant difference in the renal safety indicators between carbon dioxide absorbents during sevoflurane anesthesia (P > 0.05). However, the BUN and urine NAG-creatinine ratios at 72 hours after surgery were higher in isoflurane anesthesia in some carbon dioxide absorbent groups (P = 0.03 and 0.04, respectively).
  
  
  CONCLUSIONS
  We could not find significant differences of renal safety indicators with carbon dioxide absorbents. Although the adverse effect of carbon dioxide absorbents on renal function was not proved, consideration should be given to their contol by the regulation on their efficacy and safety because carbon dioxide absorbents can produce compound A.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyung-Chul
authors.initials: HC
authors.lastname: Lee
authors.forename: Donguk
authors.initials: D
authors.lastname: Kim
authors.forename: Wonsik
authors.initials: W
authors.lastname: Ahn
authors.forename: Jiyeon
authors.initials: J
authors.lastname: Sim
authors.forename: Yehoon
authors.initials: Y
authors.lastname: Chung