Renal functions and serum fluoride concentrations in chronic renal failure patients after sevoflurane or isoflurane anaesthesia

Sevoflurane is metabolised to hexa-fluoro-isopropanol and inorganic fluoride ions by human liver. The peak plasma fluoride level is higher after sevoflurane than after isoflurane. Although this has no effect on renal functions in normal patients and volunteers, it might be risky on those with chronic renal insufficiency. In this study, 60 patients with stable chronic renal insufficiency who required surgical intervention were randomly allocated into one of two groups each of 30 patients; sevoflurane and isoflurane groups. We compared the renal functions [serum creatinine, urea, osmolality, sodium and urine osmolality] and the serum inorganic fluoride levels afler sevoflurane to those after isoflurane anaesthesia. Peak serum inorganic fluoride concentrations were significantly higher after sevoflurane than after isoflurane anesthesia [26 +/- 3 Vs 14 +/- 2 um/L]. Laboratory measures or renal functions remained stable throughout the postoperative period in both groups. No patient suffered a permanent renal damage of preexisting renal insufficiency and non required postoperative dialysis. There is no evidence that the increased fluoride levels after sevoflurane worsened the preexisting renal impairment. We concluded that the increase in serum inorganic fluoride after sevoflurane to levels as seen in this study are of little risk to patients with chronic renal insufficiency. Further studies to evaluate the effect of compound A on the renal functions on those chronic renal impairment patients are required

Haemodynamic, early recovery and renal function effects of desflurane anasesthesia in renal transplant

Twenty adult patients scheduled for liver related renal transplant with ASA physical status III were randomly allocated into two groups; desflurane and isoflurane, each of 10 patients. All patients were optimized pre-operatively by haemodialysis, homeostasis and control of all reversible pathological parameters as high blood pressure, blood sugar and serum electrolytes. They were given midazolam i.m. premedication and received either desflurane or isoflurane in N2O/O2-fentanyl during inaintenance. Atracurium in mcremental doses was given as a muscle relaxant. Full haemodynamic monitoring started in the pre-anaesthesia room and continue perioperatively every 3min NIBP, 5-chest leads ECG, CVP [every 5-10 min], HR., Sp O2, end-t-CO2 and neuromuscular transmission. Patients were ventilated to normocarbic with a closed circuit using soda lime. Anaesthesia and operative times were recorded as well as recovery parameters times. Urine was examined for organic and inorganic fluorides and blood inorganic fluorides was measured also [at 0. 4, 24, 72h] and I, as well as full renal functions and urine volume and osmolarity were measured [at 0, 4, 24 and 192 h]. There was a significant early recovery in desflurane than isoflurane group, Heamodynamically there were no significant differences between the two groups although the response to surgical stimulation was better controlled in desflurane than isoflurane groups. Renal function was markedly improved after transplantation without significant differences between groups. There was a slight insignificant increase of serum inorganic and urinary organic and inorganic fluorides in isoflurane than desflurane groups. The low solubility and very minimal metabolism of desflurane make it a safe and reliable inhalational anaesthetic agent compared to isoflurane specially in high risk patients as renal transplant patients