The Study for Renal Effects of Increased Serum and Urinary Inorganic Fluoride Levels after Prolonged Sevoflurane Anesthesia

Yoon, Sunk Hun; Yoon, Jeong Bae; Kim, Tae Sung; Kim, Hyun Soo; Kim, Kwang Min

Abstract

BACKGROUND: Sevoflurane (CH2F-O-CH(CF3)2) is a fluorinated derivative of ethyl isoprophyl ether. Sevoflurane has a blood/gas partition coefficient of 0.60 that allows a rapid induction and emergence of anesthesia. But sevoflurane is metabolized to inorganic fluoride known as the etiologic agent of anesthetic nephrotoxicity, more than halothane and isoflurane. It is not known whether sevoflurane biotransformation produce high inorganic plasma fluoride level, thus increasing the potential for fluoride-induced renal dysfunction. The aim of this prospective study was to dertermine the levels of serum inorganic fluoride and the influnce of renal function after prolonged sevoflurane anesthesia
METHODS
In this study the serum and urine inorganc fluoride ions concentration were measured before, during, and after sevoflurane anesthesia, respectively, with urine volume and osmolarity in the prolonged sevoflurane anesthesia group (brain aneurysm patients, n=6, anesthetic time: 360 min).
RESULTS
The peak serum fluoride concentration was 71.68 microgrammol/L, 6 hours during anesthesia and then the concentration of serum inorganic fluoride decreased quickly. Peak urinary fluoride concentration was 1344+/-303.29 microgrammol/L, 8 hours after cessation of sevoflurane anesthesia, and its concentration was less than 100 microgrammol/L on the third postoperative day. No evidence of abnormal hepatorenal function occurred in the postoperative period.
CONCLUSIONS
Anesthesia with sevoflurane is safe without significant adverse effects in the patients. Although the mean peak serum fluoride levels were 71.68 microgrammo l/L no evidence of abnormal renal function occurred in any of the patients in the postoperative period.