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GENERAL ARTICLES

The Effects of Sevoflurane on Serum Creatinine and Blood Urea Nitrogen Concentrations: A Retrospective, Twenty-Two–Center, Comparative Evaluation of Renal Function in Adult Surgical Patients

Richard I. Mazze, MD^*,, Clair M. Callan, MD, Susan T. Galvez, RN, Leticia Delgado-Herrera, RPh, and David B. Mayer, MD^,

*Department of Anesthesia, Stanford University School of Medicine, Stanford, California; Palo Alto Veterans Affairs Health Care System (PAVAHCS), Palo Alto, California; Abbott Laboratories, Abbott Park, Illinois; Department of Anesthesia, University of Illinois, Chicago, Illinois; Esurg, Incorporated, Seattle, Washington

Address correspondence to Richard I. Mazze, MD, 1073 Cathcart Way, Stanford, CA 94305. Address e-mail to mazze{at}leland .stanford.edu. Address reprint requests to Ms. Susan Galvez, Abbott Laboratories, Hospital Products Division, Department 97C, Building AP30, 200 Abbott Park Rd., Abbott Park, IL 60064.

Despite mounting clinical evidence that supports its safety, the question of the potential adverse effects of sevoflurane on renal function continues to generate some controversy. This study retrospectively evaluated pooled renal laboratory data from 22 different clinical trials that compared sevoflurane with three widely used anesthetics. The trials examined postoperative changes in serum creatinine and blood urea nitrogen levels from a total of 3,436 ASA physical status I–IV adult surgical patients administered either sevoflurane (n = 1941) or a control drug (isoflurane, enflurane, or propofol; n = 1495) as the maintenance anesthetic. The incidences of increased serum creatinine and blood urea nitrogen concentrations were similar among patients administered sevoflurane and those administered control drugs. Additionally, no trends specific to sevoflurane were observed with respect to postoperative serum creatinine concentration and fresh gas flow rate, concurrent treatment with nephrotoxic antibiotics, or type of carbon dioxide absorbent.

Implications: Our data for changes in serum creatinine and blood urea nitrogen indicate that, for exposures of less than 4 minimum alveolar anesthetic concentration/h, sevoflurane is not associated with an increased risk of renal toxicity compared with other commonly used anesthetics. For clinical purposes, the pre- to postoperative changes in serum creatinine and blood urea nitrogen are appropriate measures of renal function in surgical patients.

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