Yonsei Med J.  2013 Sep;54(5):1266-1272. 10.3349/ymj.2013.54.5.1266.

Kidney Function in Living Donors Undergoing Nephrectomy by Sevoflurane or Desflurane Anesthesia

• Kim MS
• Lee JR
• Kim MS
• Ham SY
• Choi SH

• KMID: 1793178
• DOI: http://doi.org/10.3349/ymj.2013.54.5.1266

Abstract

PURPOSE
Although there is no clinical evidence of nephrotoxicity with the volatile anesthetics currently used in general anesthesia, a better agent should be needed in terms of preserving postoperative renal function in living kidney donors who have only single remaining kidney. The purpose of the current retrospective, single-center study was to evaluate and compare renal function of living kidney donors after nephrectomy under either sevoflurane or desflurane anesthesia.
MATERIALS AND METHODS
From January 2006 through December 2011, a total of 228 donors undergoing video assisted minilaparotomy surgery nephrectomy for kidney donation were retrospectively enrolled in the current study. The donors were categorized into a sevoflurane group or desflurane group based on the type of volatile anesthetic used. We collected laboratory data from the patients preoperatively, immediately after the operation, on the first postoperative day and on the third postoperative day. We also compared renal function of the kidney donors after donor nephrectomy by comparing creatinine level and estimated glomerular filtration rate (eGFR).
RESULTS
The decrease in renal function after surgery in both groups was the most prominent on the first postoperative day. There were no significant differences between the two groups in postoperative changes of creatinine or eGFR.
CONCLUSION
Sevoflurane and desflurane can be used safely as volatile anesthetics in donors undergoing nephrectomy.

Keyword

Desflurane; living donors; nephrectomy; sevoflurane

MeSH Terms

Adult
Anesthesia, General/methods
Anesthetics, Inhalation/adverse effects/*therapeutic use
Female
Humans
Isoflurane/adverse effects/*analogs & derivatives/therapeutic use
Kidney/*physiology
Kidney Function Tests
*Kidney Transplantation
*Living Donors
Male
Methyl Ethers/adverse effects/*therapeutic use
*Nephrectomy
Postoperative Complications
Retrospective Studies
Anesthetics, Inhalation
Isoflurane
Methyl Ethers

Figure

• 

  Fig. 1 Comparisons of ΔCreatinine and ΔCreatinine% between the desflurane group and sevoflurane group. The box contains the middle 50% of the data, and the line in the box indicates the median value of the data. The upper edge of the box represents the 75th percentile of the data set, and the lower edge represents the 25th percentile. The range of the middle two quartiles means the inter-quartile range. The ends of the vertical lines represent the minimum and maximum values of the data set unless outliers do not exist, in which case the vertical lines extend to a maximum of 1.5 times the inter-quartile range. Any data that does not exist between the vertical lines should be marked as an outlier with a circle. ΔCreatinine, value of postoperative creatinine-value of preoperative creatinine; ΔCreatinine%, ΔCreatinine/value of preoperative creatinine test; A, value immediately after operation-preoperative value; B, value on the first postoperative day-preoperative value; C, value on the third postoperative day-preoperative value.

• 

  Fig. 2 Comparisons of ΔeGFR and ΔeGFR% between the desflurane group and sevoflurane group. The box contains the middle 50% of the data, and the line in the box indicates the median value of the data. The upper edge of the box represents the 75th percentile of the data set, and the lower edge represents the 25th percentile. The range of the middle two quartiles means the inter-quartile range. The ends of the vertical lines represent the minimum and maximum values of the data set unless outliers do not exist, in which case the vertical lines extend to a maximum of 1.5 times the inter-quartile range. Any data that does not exist between the vertical lines should be marked as an outlier with a circle. ΔeGFR, value of postoperative estimated glomerular filtration rate-value of preoperative estimated glomerular filtration rate; ΔeGFR%, eGFR/value of preoperative estimated glomerular filtration rate; A, value immediately after operation-preoperative value; B, value on the first postoperative day-preoperative value; C, value on the third postoperative day-preoperative value.

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