Effects of closed-circuit desflurane and sevoflurane anesthesia on postoperative renal function in neurosurgical patients / 中华麻醉学杂志

ABSTRACT

Objective To compare the renal function after neurosurgery performed under closed-circuit anesthesia with sevoflurane and desflurane and determine the safety of the closed-circuit sevoflurane anesthesia. Methods 36 ASA Ⅰ or Ⅱ patients aged 18-60 years were randomly divided into 2 groups to receive either sevoflurane (group S, n = 18) or desflurane (group D, n = 18) . The duration of surgery was expected to be ≥90 min. The patients were premedicated with intramuscular midazolam 0.07 mg?kg-1 . Anesthesia was induced with midazolam 0.1 mg?kg-1, fentanyl 1.5-2.0 ?g?kg-1 , propofol 1-2 mg?kg-1 and vecuronium 0.1-0.15 mg? kg-1. The patients were mechanically ventilated (VT = 8-12 ml?kg-1) after tracheal intubation. PET CO2 was maintained a 35-45 mm Hg. Fresh gas flow (FGF) was first set at 1-5 L?min-1 for 2-3 min, then reduced to 0.18-0.3 L?min-1. In group D end-tidal desflurane concentration was maintained at 6%-10% ; whereas in group S the end-tidal sevoflurane concentration was maintained at 2.7%-4.0% . BP, HR, ECG, SpO2 PET CO2, inspiratory and expiratory O2 , desflurane and sevoflurane concentrations and the temperature in the center of soda-lime canister were continuously monitored during the operation. Gases were collected from breathing circuit for determination of compound A concentration (by gas chromatography) before anesthesia, at the end of 2-3 min wash-in, every 30 min during maintenance of anesthesia and at the end of anesthesia. Venous blood samples were taken before anesthesia (baseline) , at the end of surgery (T1) and at 2, 24 and 72 h after operation (T2-4) for determination of serum F-, creatinine (Cr) and blood urea nitrogen (BUN) concentrations. Urine specimens were taken for determination of total protein (TP), ?2-microglobulin (?2-MG) and ?-N-acetyl-glucuronidase (NAG) levels, before operation (baseline) at the end of operation and at 24, 48 and 72 h after operation. TP/Cr, ?2-MG/ Grand NAG/Cr were calculated to eliminate the influence of the volume of urine.Results There were no significant differences between the two groups with respect to age, sex, body weight, height, duration of anesthesia and temperature in the center of soda-lime canister. The inspiratory O2 concentration was ≥ 75% during anesthesia. There was no significant difference in serum Cr and BUN concentrations and NAG/Cr in urine before and after operation as well as between the two groups. TP/Cr and ?2-MG/Cr in urine were significantly increased after operation compared to the baseline values but there was no significant difference between the two groups. There was no significant correlation between postoperative TP/Cr, ?-MG/Cr and compound A. Conclusion Closed-circuit sevoflurane ansthesia does not affect postoperative renal function.