Effects of sevoflurane anesthesia combined with epidural block on renal function in the elderly: comparison with isoflurane

Hase, Kokichi; Meguro, K; Nakamura, Takako

doi:10.1007/s005400050067

Cited by 3 publications

(7 citation statements)

References 20 publications

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“…Similar results in elderly patients subjected to isoflurane and sevoflurane anaesthesia were reported by Hase et al (26). Therefore, it seems that DNA damage inflicted following exposure to both anaesthetics was of transient nature, and it is obviously present in the first hours post exposure but is mostly effectively repaired later on, without producing severe functional impairments.…”

Section: Discussionsupporting

confidence: 84%

“…Previous studies suggest that in humans 2-5 % of the absorbed dose of sevoflurane is metabolised, compared to only 0.2 to 2 % of isoflurane (3,25). Second, it is important to mention that sevoflurane biotransformation results in the formation of inorganic fluoride and the so-called compound A, which are both considered toxic and, especially, nephrotoxic (25,26). Goldberg et al (27) found that sevoflurane biotransformation resulted in the generation of greater amounts of fluoride ions than isoflurane.…”

Section: Discussionmentioning

confidence: 99%

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Sevoflurane and isoflurane genotoxicity in kidney cells of mice

Brozović

Oršolić

Rozgaj

et al. 2017

Archives of Industrial Hygiene and Toxicology

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The aim of this study was to evaluate the DNA damage and repair in kidney cells of Swiss albino mice after repeated exposure to sevoflurane and isoflurane and compare their detrimental effects. We used the alkaline comet assay to establish the genetic damage and measured three parameters: tail length, tail moment, and tail intensity of comets. These parameters were measured immediately after exposure to the above mentioned inhalation anaesthetics, two hours, six hours, and 24 hours later and were compared with the control group. Mean values of all three parameters were significantly higher in experimental groups compared to the control group. DNA damage in kidney cells of mice exposed to sevoflurane increased continuously before it reached its peak 24 hours after exposure. Isoflurane induced the highest DNA damage two hours after exposure. Levels of DNA damage recorded 24 h after cessation of exposure to both tested compounds suggest that sevoflurane was slightly more genotoxic than isoflurane to kidney cells of mice. According to these results, the currently used volatile anaesthetics sevoflurane and isoflurane are able to damage DNA in kidney cells of mice. Such findings suggest a possibility for similar outcomes in humans and that fact must be taken into account in everyday clinical practice.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Sevoflurane and isoflurane genotoxicity in kidney cells of mice

Brozović

Oršolić

Rozgaj

et al. 2017

Archives of Industrial Hygiene and Toxicology

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“…Conversions to mgÁdL -1 were done for creatinine 24,34,55,61,64,68 and BUN 24,55,61,64,67,70 from non-SI units of measurements while conversions to mean (SD) for central tendency and dispersions were needed in four more studies. 57,64,68,70 Creatinine values were extrapolated from graphical data in seven studies, 49,51,54,56,69,71,72 BUN in eight studies, 43,49,51,54,56,69,71,72 CCR in eight studies, 39,40,43,49,53,56,60,68 and peak serum fluoride in 18 studies. 35,36,39,40,42,43,[48][49][50]55,[58]…”

Section: Resultsmentioning

confidence: 99%

“…57,64,68,70 Creatinine values were extrapolated from graphical data in seven studies, 49,51,54,56,69,71,72 BUN in eight studies, 43,49,51,54,56,69,71,72 CCR in eight studies, 39,40,43,49,53,56,60,68 and peak serum fluoride in 18 studies. 35,36,39,40,42,43,[48][49][50]55,[58][59][60][61]65,68,69,73 Risk of bias assessment…”

Section: Resultsmentioning

confidence: 99%

The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials

Sondekoppam

Narsingani

Schimmel

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Renal damage secondary to fluoride ions and compound A (CpdA) after sevoflurane anesthesia remains unclear. For safety reasons, some countries still recommend minimum fresh-gas flows (FGFs) with sevoflurane. We review the evidence regarding the intraoperative use of sevoflurane for anesthesia maintenance and postoperative renal function compared with other anesthetic agents used for anesthetic maintenance. Secondarily, we examine the effects of peak plasma fluoride and CpdA levels and the effect of FGF and duration of anesthesia on these parameters. Source The databases of MEDLINE (OVID and Pubmed), EMBASE, the Cochrane Library, Health Technology Assessment Database, CINAHL, and Web of Science were searched from inception until 23 April 2020 to identify randomized-controlled trials (RCTs) in humans utilizing sevoflurane or an alternative anesthetic for anesthesia maintenance with subsequent measurements of renal function. Two different paired reviewers independently selected the studies and extracted data. The quality of the evidence was appraised using GRADE recommendations. Principal findings Of 3,766 publications screened, 41 RCTs in human patients were identified. There was no difference between creatinine at 24 hr (21 studies; n = 1,529), or creatinine clearance (CCR) at 24 hr (12 studies; n = 728) in the sevoflurane vs alternative anesthetic groups. Peak fluoride and fluoride measured at 24 hr were higher with sevoflurane compared with other inhaled anesthetics. Subgroup analyses for sevoflurane usage in various contexts showed no significant difference between sevoflurane and alternative anesthetics for creatinine or CCR at 24 hr at varying FGF, duration of exposure, baseline renal function, or absorbent use. Conclusions We did not find any association between the use of sevoflurane and postoperative renal impairment compared with other agents used for anesthesia maintenance. The scientific basis for recommending higher FGF with the use of sevoflurane needs to be revisited.

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“…Carboplatin is excreted via glomerular filtration and active renal tubular transport, 23 and healthy Beagles have been documented to have decreased glomerular filtration rate (GFR) with medetomidine anesthesia 24 . Additionally, mild, transient glomerular and tubular functional impairment has been noted after anesthesia with sevoflurane or isoflurane in elderly human patients 25 . Furthermore, carboplatin dosage reductions are recommended in people with reduced creatinine clearance 26 .…”

Section: Discussionmentioning

confidence: 99%

Adverse Effects of Concurrent Carboplatin Chemotherapy and Radiation Therapy in Dogs

Hume

Johnson

Williams

2009

Veterinary Internal Medicne

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Background: Concurrent chemo-and radiotherapy improves outcome of certain human neoplasms but with increased signs of toxicity. Reports on adverse effects of concurrent chemo-and radiotherapy in the veterinary literature are scant.Objective: To report adverse hematologic and gastrointestinal effects of combined carboplatin and radiation therapy in dogs.Animals: Client-owned dogs with spontaneously occurring neoplasia. Methods: Retrospective case study. Medical records of 65 dogs were reviewed. Criteria for inclusion were administration of radiation according to 1 of 3 fractionation schemes (19 Â 3, 16 Â 3, or 12 Â 4 Gy) and administration of at least 1 concurrent carboplatin treatment at a dosage of 200-300 mg/m 2 . Dog and treatment-related variables were analyzed for association with signs of intoxication.Results: Median carboplatin dosage was 200 mg/m 2 (range, 200-250 mg/m 2 ). Twelve of 58 dogs (21%) developed grade 3 or 4 neutropenia. Eleven of 56 dogs (20%) developed grade 3 or 4 thrombocytopenia. Six of 62 dogs (10%) developed grade 3, 4, or 5 gastrointestinal toxicosis. Analysis of association of dog and treatment-related variables with signs of intoxication was hampered by the small numbers of dogs in individual groups, and no statistically significant associations were found.Conclusions and Clinical Importance: Combined modality therapy resulted in myelosuppression and gastrointestinal toxicosis. Future studies are needed to determine whether the potential benefit of combined modality therapy outweighs the risk of decreasing chemotherapy and radiation treatment intensity.

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Effects of sevoflurane anesthesia combined with epidural block on renal function in the elderly: comparison with isoflurane

Abstract: In both groups, glomerular and tubular function were transiently affected, but no abnormalities were found in routine laboratory tests, suggesting that neither isoflurane nor sevoflurane in combination with dopamine and epidural anesthesia seriously affects renal function in the elderly.

Cited by 3 publications

References 20 publications

Sevoflurane and isoflurane genotoxicity in kidney cells of mice

Sevoflurane and isoflurane genotoxicity in kidney cells of mice

The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials

Adverse Effects of Concurrent Carboplatin Chemotherapy and Radiation Therapy in Dogs

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