Renal injury from sevoflurane in noncardiac surgery: a retrospective cohort study

Park, MiHye; Jung, Kangha; Cho, Hyun Sung; Min, Jeong-Jin

doi:10.1016/j.bja.2022.04.026

Cited by 7 publications

(4 citation statements)

References 35 publications

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“…The rate of postoperative renal dysfunction in this study was six times the rate that we reported for a cohort with fewer risk factors for renal dysfunction [19]. The rate of postoperative increases in creatinine ≥ 26.4 lmol.l -1 in men was more than twice that in women, which might be related to sex-specific physiological differences [20][21][22].…”

Section: Discussioncontrasting

confidence: 40%

The association of withholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non‐cardiac surgery

Choi,

Ryu,

Woo

et al. 2024

Anaesthesia

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SummaryBackgroundWithholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers peri‐operatively in non‐cardiac surgery remains controversial as they may result in intra‐operative hypotension and postoperative organ damage.MethodsWe included patients prescribed angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers who underwent surgical procedures > 1 h duration under general or spinal anaesthesia from January 2012 to June 2022 in a single centre. We categorised patients by whether these drugs were withheld for 24 h before surgery. We evaluated the association of withholding these drugs before non‐cardiac surgery with creatinine concentrations that increased ≥ 26.4 μmol.l‐1 in the first 48 postoperative hours (acute kidney injury). We also analysed changes in creatinine concentrations and estimated glomerular filtration rates.ResultsAngiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers were withheld in 24,285 of 32,933 (74%) patients and continued in 8648 (26%) patients. We used propensity scores for drug discontinuation to match 8631 patient pairs who did or did not continue these drugs: acute kidney injury was recorded for 1791 (21%) patients who continued these drugs vs. 1587 (18%) who did not (OR (95%CI) 1.16 (1.08–1.25), p < 0.001). Intra‐operative hypotension was recorded for 3892 (45%) patients who continued drugs vs. 3373 (39%) patients who did not (OR (95%CI) 1.28 (1.21–1.36), p < 0.001). Continuing drugs was independently associated with a mean increase in creatinine of 2.2 μmol.l‐1 (p < 0.001) and a mean decrease in estimated glomerular filtration rate of 1.4 ml.min.1.73 m‐2 (p < 0.001).ConclusionsContinuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers 24 h before non‐cardiac surgery was associated with intra‐operative hypotension and postoperative acute kidney injury.

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Section: Discussioncontrasting

confidence: 40%

The association of withholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non‐cardiac surgery

Choi,

Ryu,

Woo

et al. 2024

Anaesthesia

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“…However, several human studies reported no association between compound A and renal toxicity [ 36 , 37 ]. In particular, in a relatively recently published large-scale retrospective study conducted by Park et al [ 38 ] on non-cardiac surgery patients, the incidence of AKI was comparable between the SEVO group (2.3%, 257/11070) and the no-SEVO group (2.5%, 66/2631) ( p = 0.57), and SEVO anesthesia was not related with postoperative AKI (OR 1.32; 95% CI: 0.94–1.86; p = 0.11). Similar to previous studies, the incidence of AKI in the present study was comparable between the RMMZ (12.8%) and SEVO (10.3%) groups ( p = 1.000).…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

Lee

Kang

Ahn

et al. 2023

JPM

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Background: We evaluated the incidence of postoperative acute kidney injury (AKI) and complications when remimazolam (RMMZ) or sevoflurane (SEVO) were used in elderly patients undergoing total knee arthroplasty. Methods: Seventy-eight participants aged ≥65 were randomly allocated to either the RMMZ or SEVO group. The primary outcome was the incidence of AKI on postoperative day (POD) 2. The secondary outcomes included intraoperative heart rate (HR), blood pressure (BP), total drug administered, emergence time, postoperative complications on POD 2, and hospital length of stay (HLOS). Results: The incidence of AKI was comparable between the RMMZ and SEVO groups. The doses of intraoperative remifentanil, vasodilators, and additional sedatives were significantly higher in the RMMZ group than in the SEVO group. Overall intraoperative HR and BP tended to remain higher in the RMMZ group. The emergence time in the operating room was significantly faster in the RMMZ group; however, the time required for an Aldrete score ≥ 9 was comparable between the RMMZ and SEVO groups. Postoperative complications and HLOS were comparable between the RMMZ and SEVO groups. Conclusion: RMMZ may be recommended for patients who are expected to decrease in intraoperative vital signs. However, stable hemodynamics with RMMZ were not sufficient to influence the prevention of AKI.

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“…On the other hand, sevoflurane is metabolized to compound A and fluoride, which carry a hypothetical risk of nephrotoxicity. However, a clinically significant association between sevoflurane use and AKI has not been established in humans [21].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Intraoperative Fluid Therapy on Postoperative Renal Functions in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery: A Retrospective Observational Study

Kılıç

Onay

Kayhan

2023

JAMMR

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Aims: To investigate the effect of perioperative fluid management on postoperative renal functions in patients who underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Study Design: Retrospective observational study Place and Duration of Study: Department of Anesthesiology and Reanimation, Faculty of Medicine, Osmangazi University, Eskişehir, Türkiye between January 2018 and January 2021. Methodology: Data of 18 patients were analyzed. Hearth rate, mean arterial blood pressure, and brain oxygenation by near-infrared spectroscopy (NIRS) were evaluated in 3 CRS phases (at start, 1st hour and 2nd hour of CRS) and 4 HIPEC phases (at minute 15, 30, 45 and 60). Renal and hepatic functions, and full blood count were recorded preoperatively and at 2nd hour, 1st day, and 3rd day postoperatively. Acute kidney injury (AKI) was defined as a 1.5-fold increase in serum creatinine level according to the preoperative value. Results: There were 14 (77.8%) women and 4 (22.2%) men, with a mean age of 53.3 years old. During both CRS and HIPEC phases, no patient's cerebral NIRS values dropped more than %20 compared with the baseline value. All of the patients received <15 ml/kg/h of intravenous fluid throughout the surgery (mean fluid volume was 12 ml/kg/h). AKI was developed in two patients. Conclusion: The cornerstone of our fluid management in these patients was to adjust the amount of fluid under the guidance of urinary output and other hemodynamic indicators. In addition, excessive fluid administration was prevented with fluid infusion not exceeding 15 ml/kg/h. Although there is no evidence on optimal intraoperative fluid administration due to the limited number of studies, we hope that our study will contribute to the futher large scale, prospective, and randomized controlled trials.

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Renal injury from sevoflurane in noncardiac surgery: a retrospective cohort study

Cited by 7 publications

References 35 publications

The association of withholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non‐cardiac surgery

The association of withholding or continuing angiotensin‐converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non‐cardiac surgery

Comparison of the Incidence of Postoperative Acute Kidney Injury Following the Administration of Remimazolam or Sevoflurane in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

The Effect of Intraoperative Fluid Therapy on Postoperative Renal Functions in Patients Undergoing Hyperthermic Intraperitoneal Chemotherapy and Cytoreductive Surgery: A Retrospective Observational Study

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