Central Journal of ISA

Open Access Open Access  Restricted Access Subscription Access

The Effect of Low-Flow and High-Flow Sevoflurane Anaesthesia on Renal and Liver Function:A Comparative Study


Affiliations
1 Department of Anaesthesia & Critical Care, Pt. JNM Medical College, Raipur, India
2 Department of Anaesthesia & Critical Care Pt. JNM Medical College, Raipur, India
 

Background and Aims: Sevoflurane degradation products can affect liver and renal functions. The study was undertaken to assess the safety of low- flow sevoflurane anaesthesia and high- flow sevoflurane anaesthesia by comparing their effects on renal and liver functions. Material and Methods: The study was conducted in 100 adult patients of American Society of Anaesthesiologists physical status I or II, who underwent elective surgery under general anaesthesia. Patients were selected randomly into two groups to receive either low-flow Sevoflurane (n=50) or high-flow Sevoflurane (n=50) anaesthesia. In all these patients, preoperative renal function tests (RFT)&liver function tests (LFT) were done. RFT included blood urea, serum creatinine, creatinine clearance, urinary protein&LFT included serum bilirubin, SGOT, SGPT, ALP. The patients were induced by intravenous thiopentone [4-7 mg/kg] and succinylcholine [1-2 mg/kg] was given to facilitate tracheal intubation. Trachea was intubated with appropriate size cuffed endotracheal tube. Anaesthesia was maintained with either highflow Sevoflurane with fresh gas flow of 4.5- 7 Liters/minute or low-flow Sevoflurane with fresh gas flow of 1- 3 L/min. Blood samples were collected before operation and at 0 hour, 06 hr, 24 hr, 48 hr&72 hr postoperatively to measure Blood urea, Serum creatinine, Creatinine Clearance (CL), serum bilirubin, Serum Glutamic Oxaloacetic Transaminases (SGOT), Serum Glutamic Pyruvic Transaminases (SGPT), Alkaline phosphatase (ALP). Urine samples were collected at 24 hrs preoperatively&every 24 hrs for up to 72 hrs postoperatively to measure urine protein. Results: This study shows alterations in renal&hepatic functions in low-flow sevoflurane anaesthesia as well as high-flow sevoflurane anaesthesia. However, the alterations in renal&hepatic functions were within upper normal limit in both groups as assessed using conventional measures of hepatic&renal functions. Conclusion: We conclude that there were no statistically significant differences in the hepato-renal function by the effect of low flow and high flow sevoflurane anaesthesia and both seem to be equally safe.

Keywords

High-Flow, Kidney Function, Low-Flow, Liver Function, Sevoflurane.
User
Notifications
Font Size

  • Smith I, Nathanson M, White PF. Sevoflurane- A long- awaited volatile anesthetic. Br J Anaesth 1996; 76:435–45.

  • Evers AS, Crowdery CM, Basler JR. General Anaesthetic. In: Goodman LS, Brunton LL, Gilman A, Chabner B, Knollmann BC editors. Goodman & Gilman’s the pharmacological basis of therapeutics. New York, McGraw-Hill, 2011; 546.

  • Behne M, Wilke HJ, Harder S. Clinical Pharmacokinetics of sevoflurane. Adis 1999; 36:13–26.

  • Bito H, Ikeda K. Renal and hepatic function in surgical patients after low–flow Sevoflurane or Isoflurane Anaesthesia. Anaesth Analg 1996; 82:173–6.

  • Hamimy W, Ashour E, Afif M. Effects of Regional Epidural Ropivacaine Anaesthesia on α-Glutathione-S-Transferase: Comparison with Low Flow Sevoflurane and Total Intravenous Propofol Anaesthesia. Journal of Biological Sciences 2004; 4(3):398–404.

  • Morio M, Fuji K, Satoh N, Imai M, Kawakami U, Mizuno T et al. Reaction of sevoflurane and its degradation products with sodalime: Toxicity of the by products. Anesthesiology 1992; 77:1155.

  • Kharash ED , Frink EJ Jr, Zager R, Bowdle TA, Artru A, Nogami WM. Assessment of low-flow Sevoflurane & Isoflurane effects on renal function using sensitive markers of tubular toxicity. Anesthesiology 1997; 86:1238–53.

  • Eger El, Koblin DD, Bowland T, Ionescu P, Laster MJ, Fang Z et al. Nephrotoxicity of Sevoflurane versus Desflurane anesthesia in volunteers. Anaesth Analg 1997; 84:160–8.

  • Sahin SH, Cinar SO, Paksoy I, Sut N, Oba S. Comparison between low flow Sevoflurane anaesthesia & total intravenous anaesthesia during intermediate-duration surgery: Effects on renal & hepatic toxicity. Hippokratia 2011 Jan-Mar; 15(1):69–74.

  • Kim JW, Kim JD, Yu SB, Ryu SJ. Comparison of hepatic & renal function between Inhalation anaesthesia with Sevoflurane and Remifentanil and Total Intravenous anaesthesia with Propofol and Remifentanil for thyroidectomy. Korean J Anesthesiol 2013; 64(2):112–6.

  • Nishiyama T, Yokoyama T, Hanaoka K. Liver and renal function after repeated Sevoflurane or Isoflurane anaesthesia. Can J Anaesth 1998; 45:789–93.

  • Kharasch ED, Frink EJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long duration low-flow Sevoflurane and Isoflurane effects on post-operative renal and hepatic function. Anaesth Analg 2001; 93:1511–20.

  • Obata R, Bito H, Ohmura M, Moriwaki G, Ikeuchi Y, Katoh T et al. The effects of prolonged low-flow Sevoflurane anaesthesia on renal and hepatic function. Anaesth Analg 2000; 91:1262–8.

  • Ebert TJ, Arain SR. Renal responses to low-flow Desflurane, Sevoflurane and Propofol in patients. Anesthesiology 2000; 93:1401–6.

  • Lin IH, Fan SZ, Chen HM, Lee JJ, Cheng SJ, Chang HH et al. Changes in biomarkers of hepatic & renal function after prolonged general anaesthesia for oral cancer surgery: A cohort comparison between desflurane & Sevoflurane. Journal of Dental Sciences 2013; 8:385–91.

  • Groudine SB, Fragen RJ, Kharasch ED, Eisenman TS, Frink EJ, McConnel S. Comparison of renal function following anaesthesia with lowflow Sevoflurane and Isoflurane. J Clin Anesth 1999; 11:201–7.

  • Hanaki C, Fujii K, Morio M, Tashima T. Decomposition of sevoflurane by sodalime. Hiroshima J Med Sci 1987; 36:61.

  • Frink EJ Jr, Malan TP, Morgan SE, Brown EA, Malcomson M, Gandolfi AJ et al. Quantification of the degradation products of sevoflurane in two CO2 absorbents during low-flow anesthesia in surgical patients. Anesthesiology 1992; 77:1064.


Abstract Views: 270

PDF Views: 107




  • The Effect of Low-Flow and High-Flow Sevoflurane Anaesthesia on Renal and Liver Function:A Comparative Study

Abstract Views: 270  |  PDF Views: 107

Authors

Pratibha Jain Shah
Department of Anaesthesia & Critical Care, Pt. JNM Medical College, Raipur, India
Jaya Lalwani
Department of Anaesthesia & Critical Care, Pt. JNM Medical College, Raipur, India
Kriti Pandey
Department of Anaesthesia & Critical Care Pt. JNM Medical College, Raipur, India
Kamal Kishore Sahare
Department of Anaesthesia & Critical Care Pt. JNM Medical College, Raipur, India
Sumitra Uraon
Department of Anaesthesia & Critical Care Pt. JNM Medical College, Raipur, India

Abstract


Background and Aims: Sevoflurane degradation products can affect liver and renal functions. The study was undertaken to assess the safety of low- flow sevoflurane anaesthesia and high- flow sevoflurane anaesthesia by comparing their effects on renal and liver functions. Material and Methods: The study was conducted in 100 adult patients of American Society of Anaesthesiologists physical status I or II, who underwent elective surgery under general anaesthesia. Patients were selected randomly into two groups to receive either low-flow Sevoflurane (n=50) or high-flow Sevoflurane (n=50) anaesthesia. In all these patients, preoperative renal function tests (RFT)&liver function tests (LFT) were done. RFT included blood urea, serum creatinine, creatinine clearance, urinary protein&LFT included serum bilirubin, SGOT, SGPT, ALP. The patients were induced by intravenous thiopentone [4-7 mg/kg] and succinylcholine [1-2 mg/kg] was given to facilitate tracheal intubation. Trachea was intubated with appropriate size cuffed endotracheal tube. Anaesthesia was maintained with either highflow Sevoflurane with fresh gas flow of 4.5- 7 Liters/minute or low-flow Sevoflurane with fresh gas flow of 1- 3 L/min. Blood samples were collected before operation and at 0 hour, 06 hr, 24 hr, 48 hr&72 hr postoperatively to measure Blood urea, Serum creatinine, Creatinine Clearance (CL), serum bilirubin, Serum Glutamic Oxaloacetic Transaminases (SGOT), Serum Glutamic Pyruvic Transaminases (SGPT), Alkaline phosphatase (ALP). Urine samples were collected at 24 hrs preoperatively&every 24 hrs for up to 72 hrs postoperatively to measure urine protein. Results: This study shows alterations in renal&hepatic functions in low-flow sevoflurane anaesthesia as well as high-flow sevoflurane anaesthesia. However, the alterations in renal&hepatic functions were within upper normal limit in both groups as assessed using conventional measures of hepatic&renal functions. Conclusion: We conclude that there were no statistically significant differences in the hepato-renal function by the effect of low flow and high flow sevoflurane anaesthesia and both seem to be equally safe.

Keywords


High-Flow, Kidney Function, Low-Flow, Liver Function, Sevoflurane.

References