Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study

Franzén, Stephanie; Semenas, Egidijus; Taavo, Micael; Mårtensson, Johan; Larsson, Anders; Frithiof, Robert

doi:10.1016/j.bja.2022.02.030

Cited by 18 publications

(14 citation statements)

References 38 publications

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“…In a recently published randomized clinical study we also noticed that patients anesthetized with sevoflurane showed increased post-operative plasmarenin and plasma creatinine levels as compared to propofol anesthesia. 42 According to previous investigations, the pronounced impairment in renal excretory function by sevoflurane anesthesia seem most likely to be due to increased renal sympathetic nerve activity, which under experimental conditions remains high even after fluid resuscitation. 43 It is also recognized that the increase in renal sympathetic activity and release of norepinephrine is responsible for an increase in renal afferent arteriolar constriction and activation of beta-adrenergic receptor on juxtaglomerular cells, 44,45 leading to an increase in renin secretion and, ultimately, an increase in aldosterone secretion.…”

Section: Discussionmentioning

confidence: 93%

Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery

et al. 2023

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Background Hospital-acquired hyponatremia remains a feared event in patients receiving hypotonic fluid therapy. Our objectives were to assess post-operative plasma-sodium concentration and to provide a physiological explanation for plasma-sodium levels over time in children with acute appendicitis. Methods Thirteen normonatremic (plasma-sodium ≥135 mmol/L) children (8 males), median age 12.3 (IQR 11.5–13.5) years participated in this prospective observational study (ACTRN12621000587808). Urine was collected and analyzed. Blood tests, including renin, aldosterone, arginine-vasopressin, and circulating nitric oxide substrates were determined on admission, at induction of anesthesia, and at the end of surgery. Results On admission, participants were assumed to be mildly dehydrated and were prescribed 50 mL/kg of Ringer’s acetate intravenously followed by half-isotonic saline as maintenance fluid therapy. Blood tests, urinary indices, plasma levels of aldosterone, arginine-vasopressin, and net water-electrolyte balance indicated that participants were dehydrated on admission. Although nearly 50% of participants still had arginine-vasopressin levels that would have been expected to produce maximum antidiuresis at the end of surgery, electrolyte-free water clearance indicated that almost all participants were able to excrete net free water. No participant became hyponatremic. Conclusions The use of moderately hypotonic fluid therapy after correction of extracellular fluid deficit is not necessarily associated with post-operative hyponatremia. Impact Our observations show that in acutely ill normonatremic children not only the composition but also the amount of volume infused influence on the risk of hyponatremia. Our observations also suggest that perioperative administration of hypotonic fluid therapy is followed by a tendency towards hyponatremia if extracellular fluid depletion is left untreated. After correcting extracellular deficit almost all patients were able to excrete net free water. This occurred despite nearly 50% of the cohort having high circulating plasma levels of arginine-vasopressin at the end of surgery, suggesting a phenomenon of renal escape from arginine-vasopressin-induced antidiuresis.

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Section: Discussionmentioning

confidence: 93%

Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery

et al. 2023

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“…In two clinical trials, plasma renin concentration was used as proxy for RSNA during sevoflurane anesthesia. 23,45 In a pediatric study, children had lower urine output and sodium excretion when anesthetized compared with when conscious. 45 Also, plasma levels of renin, but not vasopressin, were higher during sevoflurane anesthesia than when the children were conscious.…”

Section: Measurement Of Rsnamentioning

confidence: 99%

“…Moreover, a clinical trial randomized adults who underwent elective spinal surgery to either propofol or sevoflurane anesthesia. 23 The sevoflurane-anesthetized patients were oliguric and had reduced sodium excretion and high levels of plasma renin during anesthesia (before surgery). These effects were not seen in patients who underwent propofol anesthesia.…”

Section: Measurement Of Rsnamentioning

confidence: 99%

“…29,30 Still, low urine production during surgery does not always translate into AKI, as many oliguric patients do not develop postoperative AKI. 23,31 It has been shown that anesthesia reduces urine output and that volatile anesthesia causes increased fluid accumulation. 32,33 This implies that anesthesia could affect renal excretory function without actually resulting in structural damage to the kidney or later renal impairment, which makes it more complicated to predict renal function based on changes in urine output during anesthesia.…”

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confidence: 99%

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Anesthesia and the renal sympathetic nervous system in perioperative AKI

Franzén

DiBona²,

Frithiof

2022

Seminars in Nephrology

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“…While many factors may contribute to the development of AKI, it is most frequently caused by acute tubular necrosis secondary to perioperative hypovolemia and hypotension. A recent single-center parallel randomized control study assessing perioperative renal function in patients anesthetized with either TIVA or sevoflurane found that sevoflurane anesthesia reduced urine output and sodium excretion and increased plasma renin concentrations compared with TIVA anesthesia [ 42 ]. The Volatile Anesthetic Protection Of Renal Transplants-1 (VAPOR-1) randomized controlled trial compared the impact of propofol vs. sevoflurane-based anesthesia during living donor kidney transplantation and found that while urinary biomarkers of kidney injury were increased on day 2 in the sevoflurane group, no significant differences in graft outcomes were seen.…”

Section: Potential Advantages Of Tiva For Hepatic Resectionmentioning

confidence: 99%

Total intravenous anesthesia for liver resections: anesthetic implications and safety

Tan

Hwang

2022

Korean J Anesthesiol

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Inhalational anesthetics have been the default agents for general anesthesia maintenance for several decades. However, with advances in total intravenous anesthesia (TIVA) and a growing body of evidence on the potential benefits of TIVA, anesthesiologists need to question this paradigm. Some of the benefits of propofol-based TIVA, such as its antiemetic properties and patients' smooth emergence, are widely acknowledged. A growing body of evidence suggests that TIVA may potentially benefit the immune system and cancer outcomes. From an existential health perspective, there is evidence that inhalational agents have a materially higher global warming potential than propofol-based TIVA. Despite the compelling potential benefits of propofol-based TIVA, there are barriers to its widespread adoption. To examine the applicability of TIVA as a mainstay agent more rigorously, we discuss the safety and applicability of propofol-based TIVA in the context of complex major abdominal surgery, specifically, liver resection surgery. We also discuss the use of propofol-based TIVA in liver resection surgery with a broad, integrated approach, addressing general and specific clinical considerations, economic factors, and operating room turnover.

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Renal function during sevoflurane or total intravenous propofol anaesthesia: a single-centre parallel randomised controlled study

Cited by 18 publications

References 38 publications

Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery

Perioperative water and electrolyte balance and water homeostasis regulation in children with acute surgery

Anesthesia and the renal sympathetic nervous system in perioperative AKI

Total intravenous anesthesia for liver resections: anesthetic implications and safety

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