A comparison of the effects of prolonged (>10 Hour) low-flow sevoflurane, high-flow sevoflurane, and low-flow isoflurane anaesthesia on hepatorenal function in orthopaedic patients

• Published in: Anaesthesia and intensive care Vol. 32; no. 2; pp. 210 - 218
• Main Authors: FUKUDA, H, KAWAMOTOT, M, YUGE, O, FUJII, K
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.04.2004; Sage Publications Ltd
• Subjects: Adult; Anesthesia; Anesthesia, Inhalation; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Inhalation - pharmacology; Biological and medical sciences; Biomarkers - analysis; Chromatography, Gas; Ethers - administration & dosage; Ethers - pharmacology; Female; Hepatorenal Syndrome - chemically induced; Humans; Hydrocarbons, Fluorinated - administration & dosage; Hydrocarbons, Fluorinated - pharmacology; Isoflurane - administration & dosage; Isoflurane - pharmacology; Kidney - drug effects; Kidney - physiology; Kidney Function Tests; Liver - drug effects; Liver - physiology; Liver Function Tests; Male; Medical sciences; Methyl Ethers - administration & dosage; Methyl Ethers - pharmacology; Sevoflurane; Surgical Flaps; Time Factors; Human; Sevoflurane; hepatorenal dysfunction; SEVOFLURANE: low-flow; General anesthetic; compound A; Anesthesia; Comparative study; Isoflurane; Prolonged; anaesthesia
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X0403200208

This study compared the effects of low-flow sevoflurane, high-flow sevoflurane and low-flow isoflurane on hepatorenal function during and after more than 10 hours of anaesthesia. Twenty-five patients scheduled for elective orthopaedic surgery were categorized into three groups; low-flow sevoflurane (fresh gas flow at 1 litre/min, n = 9), high-flow sevoflurane (5 l/rmin, n = 7), or low-flow isoflurane (1 l/min, n=9). Inspiratory compoundA concentrations were measured. The groups had similar duration of anaesthesia and exposure to anaesthetic agents. The area under the curve of concentration (mean, SD) of compound A in the low-flow sevoflurane group (359.8, 106.1 ppm.h) was greater than that in the high-flow sevoflurane group (61.1, 29.3 ppm.h; P<0.01). All groups showed normal plasma creatinine and creatinine clearance, and transient postoperative increases in plasma alanine aminotransferase and alpha glutathione-S-transferase, as well as urinary glucose and alpha glutathione-S-transferase, with no significant differences between groups. There were no significant relationships between the area under the curve of concentration of compound A and the biomarkers. These findings suggest that prolonged anaesthesia with low-flow sevoflurane has similar effects on hepatorenal function to prolonged anaesthesia with high-flow sevoflurane and low-flow isoflurane.