Changes Ln Serum Uric Acid Concentrations After Caesarean Section Using Methoxyflurane

Hamilton, W. F.; Robertson, Graham; Campbell, Douglas L.

doi:10.1093/bja/47.4.508

Cited by 2 publications

(1 citation statement)

References 17 publications

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“…In PET, the production of urate may be increased and destruction in the liver decreased, but renal excretion remains constant with approximately 80% of renal elimination attributable to secretion in the distal tubule (Chesley, 1978). Hamilton, Robertson and Campbell (1975) showed that hyperuricaemia in PET was increased when methoxyflurane was used during Caesarean section. Hyperuricaemia was a constant feature of PET in our patients, but there were no important differences between those patients receiving halothane and those receiving enflurane, providing further evidence that neither agent induced tubular dysfunction.…”

Section: Discussionmentioning

confidence: 99%

General Anaesthesia for Caesarean Section in Severe Pre-Eclampsia

Crowhurst

Rosen

1984

British Journal of Anaesthesia

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In a randomized study of patients undergoing Caesarean section, either enflurane (mean 0.24 MAC-h) or halothane (mean 0.23 MAC-h) and 50% nitrous oxide in oxygen were administered to women (n = 12) with severe pre-eclampsia-eclampsia and to 16 healthy pregnant patients with normal renal and hepatic function. No evidence of nephrotoxicity was found in any pre-eclamptic or normal patient. Metabolism of enflurane resulted in plasma inorganic fluoride concentrations (max 15 mumol litre -1) which were well below the toxic value. Postoperative liver function tests showed no important changes from preoperative values, although reductive metabolites of halothane were not measured. In patients with severe pre-eclampsia there appears no contraindication to enflurane or, probably, halothane as volatile supplements during general anaesthesia.

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Section: Discussionmentioning

confidence: 99%

General Anaesthesia for Caesarean Section in Severe Pre-Eclampsia

Crowhurst

Rosen

1984

British Journal of Anaesthesia

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Toxicity following methoxyflurane anaesthesia

Samuelson

Merin

Taves

et al. 1976

Canad. Anaesth. Soc. J.

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SINCE THE PUBLICATION Of the initial reports from this institution, 1-:* the pathophysiology and aetiology of the nephrotoxicity following the administration of methoxyflurane have been explored rather completely. Various studies have established that the defect in the concentrating ability of the kidney is related to the effect of fuoride ion resulting from the biotransformation of methoxyfluraue. 4-r' As expected, a correlation between methoxyflurane dose and serum fluoride ion has been demonstrated, but there have been rather large individual differences in every study. 5,~uo,u,l:~,~4 Presumably these variations are related to differences in either uptake and distribution of the anaesthetic or the rates of biotransformation. Although a logical scheme for the metabolic pathways involved has been proposed, 4'5 the appropriate labelling studies have not been done to confirm these hypothetical pathways in man. In particular, the role of the organic fluorinated metabolites in providing a source of continuing fluoride ion has not been elucidated. In view of the very high lipid solubility of methoxyflurane, obese patients might be expected to take up more of the administered drug and hence have a larger store available for metabolism. In a previous publication we saw such an effect in one patient, but were unable to draw any meaningful conclusionsY ~ The present study was designed to compare the effects of a standard exposure to methoxyfturane in normal and obese patients under as rigorous controls as possible in a clinical setting. A group of patients receiving another anaesthetic technique was also included as a control. In addition to the usual measures of renal function and fluoride ion concentration, the organic metabolite and renal clearances were also studied in an attempt to understand the puzzling differences in individual susceptibility to the nephrotoxicity of methoxyflurane. METHODSTwenty patients scheduled for elective operations outside the body cavities were studied. (Table I) All patients were hospitalized for at least 24 hours before operation. None had a history of prior renal or hepatic disease, significant cardiopulmonary dysfunction, or long-term drug therapy. The design of tile stud), and the procedures were described to the patients and informed consent was obtained l)epartments

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Changes Ln Serum Uric Acid Concentrations After Caesarean Section Using Methoxyflurane

Cited by 2 publications

References 17 publications

General Anaesthesia for Caesarean Section in Severe Pre-Eclampsia

General Anaesthesia for Caesarean Section in Severe Pre-Eclampsia

Toxicity following methoxyflurane anaesthesia

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