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ANESTHETIC PHARMACOLOGY

The Effects of Low-Flow Sevoflurane and Isoflurane Anesthesia on Renal Function in Patients with Stable Moderate Renal Insufficiency

Hideyuki Higuchi, MD^*, Yushi Adachi, MD, Hiroki Wada, MD, Masuyuki Kanno, MD^*, and Tetsuo Satoh, MD

*Department of Anesthesia, Self Defense Force Central Hospital, Tokyo, Japan; and Department of Anesthesiology, National Defense Medical College, Saitama, Japan

Address correspondence and reprint requests to Hideyuki Higuchi, MD, Department of Anesthesia, Self Defense Force Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo 154-8532, Japan. Address e-mail to higu-chi{at}ka2.so-net.ne.jp

Sevoflurane degrades to Compound A, which is nephrotoxic in rats. Therefore, the renal effects of Compound A is an area of intense debate. We investigated the effects of low-flow sevoflurane and isoflurane anesthesia on renal function in patients with stable renal insufficiency. Seventeen patients with a serum creatinine level of more than 1.5 mg/dL were anesthetized with sevoflurane or isoflurane at a total flow of 1 L/min. Serum creatinine and blood urea nitrogen were measured before anesthesia and again 1, 2, 3, 5, 7, and 14 days after anesthesia. The 24-h creatinine clearance was measured before anesthesia and 7 days after anesthesia. There were no significant differences in the blood urea nitrogen levels, serum creatinine concentrations, or creatinine clearance before and after anesthesia within each group. These results suggest that sevoflurane and isoflurane have similar effects on renal function in patients with moderately impaired renal function. Further study of the effects of low-flow sevoflurane anesthesia on impaired renal function with a larger sample size than ours is required to resolve the issue of sevoflurane safety in patients with renal insufficiency.

Implications: The serum creatinine and blood urea nitrogen data indicate that, for exposures of <130 ppm/h in Compound A inspired area under the curve, renal effects of low-flow sevoflurane are similar to those of isoflurane in patients with stable renal insufficiency.