Renal Safety and Extrahepatic Defluorination of Sevoflurane in Hepatic Transplantations (original) (raw)

2007, Transplantation Proceedings

Background. The main metabolic pathway for defluorination of sevoflurane in the liver produces inorganic fluoride (Fl). The metabolism and effect of sevoflurane on the kidney is not clear during anhepatic phase in liver transplantation. The goal of the present study was to investigate the metabolism and renal effect of sevoflurane by measuring plasma and urine inorganic fluoride, urinary N-acetyl-glucosaminidase (NAG), and plasma creatinine levels in patients undergoing liver transplantations. Methods. After institutional approval and informed consent, we studied nine cases of orthotopic liver transplantation after anesthesia was induced with 5 mg • kg Ϫ1 thiopental, 1 g • kg Ϫ1 fentanyl intravenously, the trachea was intubated after vecuronium bromide 0.1 mg • kg Ϫ1. Anesthesia was maintained with sevoflurane (2%), O 2 , and N 2 O at a total gas flow of 6 L • min Ϫ1 using a semiclosed circle system with a sodalime canister. Blood and urine samples were obtained to measure plasma and urine fluoride concentrations and urinary NAG excretions before induction (P0), hourly during resection (P1, P2, P3), every 15 minutes during anhepatic phase (A1, A2, A3), hourly after reperfusion (neohepatic phase) (N1, N2, N3), and postoperative first hour (Po1). Preoperative (T0) and postoperative day 1 (T1), 3 (T3), 7 (T7) plasma blood urea nitrogen (BUN) and creatinine (Cr) levels were also recorded. Results. Mean duration of surgery was 9:06 Ϯ 0:09 hours. Mean inorganic fluoride concentrations in plasma were in the range of 0.71 Ϯ 0.30 to 28.73 Ϯ 3.31 mole • L Ϫ1. In P3, N1, N2, N3, increases in plasma inorganic fluoride concentrations were significant (P Ͻ .05) and reached a peak value at Po1. The mean urine inorganic fluoride concentrations were 12.49 Ϯ 2.04 to 256.7 Ϯ 49.62 mole • L Ϫ1. In A2, A3, N1, N2, and