Sevoflurane renal effects

Hase K, Meguro K, Nakamura T. Assessment of renal effects of sevoflurane in elderly patients using urinary markers. Anesth Analg 1999 88(6) 1426-7. 

CookTL, Beppu WJ, Hitt BA, Kosek JC, Mazze Rl. A comparison of renal effects and metabolism of sevoflurane and methoxyflurane In enzyme-induced rats. Anesth Anaig 1975 54(6) 829-35. 

Mazze Rl, Jamison R. Renal effects of sevoflurane. Anesthesiology 1995 83(3) 443-5. 

The effects of sevoflurane, isoflurane, and desflurane on macroscopic renal structure have been studied in 24 patients undergoing nephrectomy (14). All the anesthetics were... 

In a randomized study of the renal and hepatic effects of prolonged low-flow anesthesia with sevoflurane or iso-flurane in patients undergoing prolonged operations (over 8 hours), using a technique that maximized compound A production, there were no differences in markers of hepatocellular injury at 24 or 72 hours (32). 

The effects of sevoflurane, isoflurane, and desflurane on macroscopic renal structure have been studied in 24 patients undergoing nephrectomy (35). All anesthetics were administered using a fresh gas flow of 11/minute and a sodium hydroxide absorber and had an average duration of 3 hours. No injury to nephrons was observed by pathologists blinded to which anesthetic agent had been used. Postoperative creatinine concentrations and urine volumes did not differ significantly between the groups. 

The effect on renal function of minimal-flow (as opposed to low-flow) anesthesia with sevoflurane and isoflurane has been examined in a randomized trial in 76 patients (33). There were no significant differences between the groups in blood chemistry markers of renal or hepatic function or in urinary markers of tubular injury, despite high exposure to compound A in the patients who received sevoflurane. 

These studies have confirmed earlier findings that although there is biochemical evidence of renal damage after sevoflurane anesthesia, there are no clinically significant effects. 

The effect of the uricosuric agent probenecid in prolonged sevoflurane anesthesia has been examined in 64 patients randomized to receive high-flow or low-flow anesthesia with sevoflurane with or without preoperative oral probenecid (61). There were no differences in urea, creatinine, or creatinine clearance among the treatments. However, patients who received low-flow sevoflurane had some evidence of renal tubular injury (raised urinary markers) compared with those who received either high-flow anesthesia or probenecid. 

Mazze RI, Callan CM, Galvez ST, Delgado-Herrera L, Mayer DB. The effects of sevoflurane on serum creatinine and blood urea nitrogen concentrations a retrospective, twenty-two-center, comparative evaluation of renal function in adult surgical patients. Anesth Analg 2000 90(3) 683-8. 

Higuchi H, Sumita S, Wada H, Ura T, Ikemoto T, Nakai T, Kanno M, Satoh T. Effects of sevoflurane and isoflurane on renal function and on possible markers of nephrotoxicity. Anesthesiology 1998 89(2) 307-22. 

McGrath BJ, Hodgins LR, DeBree A, Frink EJ Jr, Nossaman BD, Bikhazi GB. A multicenter study evaluating the effects of sevoflurane on renal function in patients with renal insufficiency. J Cardiovasc Pharmacol Ther 1998 3(3) 229-34. 

Higuchi H, Wada H, Usui Y, Goto K, Kanno M, Satoh T. Effects of probenecid on renal function in surgical patients anesthetized with low-flow sevoflurane. Anesthesiology 2001 94(1) 21-31. 

Numerous studies have addressed the same issues raised with enflurane regarding fluoride production and nephrotoxic potential including fluoride levels after prolonged exposure [56,57,59], urine concentrating ability [57, 59-61], the effect of obesity [57, 60], and the effect of preexisting renal function impairment [62,63]. The findings demonstrated that sevoflurane has little or no potential for fluoride-induced nephrotoxicity (For further information see section on mechanisms of fluoride toxicity). 

NIshlyama T, Hirasaki A. Effects of sevoflurane anaesthesia on renal function-duration of administration and area under the curve and rate of decrease of serum inorganic fluoride. Eur J Anaesthesiol 1995 12(5) 477-82. 

Tsukamoto N, HirabayashiY, Shimizu R, Mitsuhata H. The effects of sevoflurane and isoflurane anesthesia on renal tubular function in patients with moderately impaired renal function. Anesth Anaig 1996 82(5) 909-13. 

Bito El, Ikeuchi Y, Ikeda K. Effects of low-flow sevoflurane anesthesia on renal function comparison with high-flow sevoflurane anesthesia and low-flow isoflurane anesthesia. Anesthesiology 1997 86(6) 1231-7. 

Kharasch ED, Frink EJ, Jr., Zager R, Bowdle TA, Artru A, Nogami WM. Assessment of low-flow sevoflurane and isoflurane effects on renal function using sensitive markers of tubular toxicity. Anesthesiology 1997 86(6) 1238-53. 

In summary The available information indicates that sevoflurane anesthesia is nontoxic to the kidney as long as exposure to compound A is kept below 150 ppm/hour. However, there are significant questions regarding the potential for compound A to cause renal injury are larger doses than 160 ppm/hour harmful Do they cause histologically detectable tissue damage Is there a cumulative effect of repeated exposures Are particular patients more prone to injury ... 

Those who regularly drink alcohol may need more thiopental or propofol than those who do not. In theory, alcohol may increase the risk of renal damage with sevoflurane. It is also probably unsafe to drink for several hours following anaesthesia because of the combined central nervous depressant effects. 

Isoniazid may increase the metabolism of enflurane, isoflurane or sevoflurane in some patients (probably related to isoniazid acetylator phenotype ) and so increase the release of fluoride ions that may cause nephrotoxicity. However, there do not appear to be any reports of a significant clinical effect on renal function. 

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