The Effects of Chemotherapeutic Agents on Renal Function during Continuous Hyperthermic Peritoneal Perfusion / 대한구급학회지

BACKGROUND: Continuous hyperthermic peritoneal perfusion (CHPP) has been introduced to improve the survival of the advanced cancer patients. It is a technique that allows uniform delivery of cytotoxic agents and heat to the peritoneal surface. However CHPP - induced acute changes of body temperature and intraabdominal pressure could produce various abnormal physiologic responses, especially hypoperfusion and hypoxia. These factors may further contribute to the renal dysfunction. Moreover, transperitoneal absorption of drugs resulting in systemic toxicity and certain anticancer drugs have an inherent nephrotoxicity. The aim of the present study was to investigate the effect of anticancer drugs on the kidney in the ovarian cancer patients after CHPP. METHODS: CHPP with anticancer agents in warm saline was performed in 54 patients with cancer of the ovary at temperature 47 degrees C for 90 minutes under general anesthesia. Forty nine patients were given carboplatin and 5 patients were received cisplatin intraperitoneally at an equi-toxic dose. To clarify the effect of cisplatin and carboplatin on the kidney, serum creatinine and blood urea nitrogen (BUN) were measured before anesthesia, 1, 3 and 7th day after surgery in both agents. RESULTS: There were no significant changes of creatinine level on 1, 3 and 7 days postoperatively compared to preoperative creatinine in carboplatin patients. In carboplatin patients, postoperative BUN levels were decreased significantly on 1 and 3 days, but they were within normal range. BUN level of postoperative 7 day showed no significant change. In cisplatin patient, there was insignificant increase of BUN and creatinine levels on 1, 3 and 7 days postoperatively. CONCLUSIONS: These results suggest that carboplatin did not suppress renal function until 7 days after CHPP. Cisplatin markedly increased the creatinine and BUN until 7 days postoperatively, but there was no statistical significance.

The Study for Renal Effects of Increased Serum and Urinary Inorganic Fluoride Levels after Prolonged Sevoflurane Anesthesia / 대한마취과학회지

BACKGROUND: Sevoflurane (CH2F-O-CH(CF3)2) is a fluorinated derivative of ethyl isoprophyl ether. Sevoflurane has a blood/gas partition coefficient of 0.60 that allows a rapid induction and emergence of anesthesia. But sevoflurane is metabolized to inorganic fluoride known as the etiologic agent of anesthetic nephrotoxicity, more than halothane and isoflurane. It is not known whether sevoflurane biotransformation produce high inorganic plasma fluoride level, thus increasing the potential for fluoride-induced renal dysfunction. The aim of this prospective study was to dertermine the levels of serum inorganic fluoride and the influnce of renal function after prolonged sevoflurane anesthesia METHODS: In this study the serum and urine inorganc fluoride ions concentration were measured before, during, and after sevoflurane anesthesia, respectively, with urine volume and osmolarity in the prolonged sevoflurane anesthesia group (brain aneurysm patients, n=6, anesthetic time: 360 min). RESULTS: The peak serum fluoride concentration was 71.68 microgrammol/L, 6 hours during anesthesia and then the concentration of serum inorganic fluoride decreased quickly. Peak urinary fluoride concentration was 1344+/-303.29 microgrammol/L, 8 hours after cessation of sevoflurane anesthesia, and its concentration was less than 100 microgrammol/L on the third postoperative day. No evidence of abnormal hepatorenal function occurred in the postoperative period. CONCLUSIONS: Anesthesia with sevoflurane is safe without significant adverse effects in the patients. Although the mean peak serum fluoride levels were 71.68 microgrammo l/L no evidence of abnormal renal function occurred in any of the patients in the postoperative period.