Comparison between low flow sevoflurane anesthesia and total intravenous anesthesia during intermediate-duration surgery: effects on renal and hepatic toxicity.

BACKGROUND: Renal and hepatic dysfunction or injury might be involved by ether based anesthetic and intravenous anesthetic drug or surgical stress. The purpose of this study is to compare the effect of moderate duration low-flow sevoflurane versus total intravenous anesthesia on renal and hepatic functions. PATIENTS AND METHODS: Eighty (80) patients between the ages of 25-70 scheduled for elective lumbar disc herniotomy, with an expected operation time of 120-240 min, were enrolled in the study. Anesthesia was induced using remifentanil, propofol and atracurium. Patients were randomly divided into two groups. After intubation, Group S (n=40) received sevoflurane and Group T (n=40) received total intravenous anesthesia with propofol in oxygen and air with a fresh gas flow of 5 L min(?1). Ten minutes after induction the fresh gas flow was decreased to 1L min(?1) in both groups. Serum BUN, creatinine, ALT, AST, LDH and 24 hours excretion of glucose, protein, and creatinine in urine were measured preoperatively and the first three postoperative days. RESULTS: Serum BUN at 48 hours, creatinine at 24, 48. hours, and urine glucose at 24, and 48 hours were significantly higher from the preoperative values in Group S (p<0.05). However, serum BUN and creatinin, urine glucose were within the normal range. There were no significant differences in the renal and hepatic function tests between the groups. CONCLUSIONS: These results show that the renal and hepatic effect of moderate duration low-flow sevoflurane and total intravenous anesthesia is similar.

Isolated bilateral paralysis of the hypoglossal and recurrent laryngeal nerves (Bilateral Tapia's syndrome) after transoral intubation for general anesthesia.

Tapia's syndrome is due to extracranial involvement of the hypoglossal nerve and the recurrent laryngeal branch of the vagal nerve. The injury of these nerves is a rare complication of anesthetic airway management. We present a patient with a postoperative bilateral hypoglossal and recurrent laryngeal nerves palsy after uncomplicated orotracheal intubation. Corticosteroid therapy was started after diagnosis. Forty-eight hours later, the movements of the vocal cords started to recover and full recovery was achieved by the fourth day. Within 3 days, tongue mobility was gradually improved and the patient's symptoms resolved completely by 4 weeks.