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Abstract
The present study has been performed in the Departments of Anesthesia, Pharmacology and Clinical Pathology, Faculty of Medicine, Zagazig University. The aim of the study was a trial to evaluate the effects of sevoflurane anesthesia on renal function, both clinically and experimentally. In the clinical part, 50 adult patients of both sexes class II and III of American Society of Anesthesiologists (ASA) classification with stable renal insufficiency, not receiving hemodialysis with serum creatinine more than 2 mg/dl, these patients were subjecsted to different elective surgical operations, divided into two equal groups (A and B). In group A, anesthesia was induced by thiopentane sodium 5-7 mg/kg and fentanyl 2 ?g/kg. Tracheal intubation was facilitated with intravenous atracurium 0.6 mg/kg. Anesthesia was maintained by sevoflurane 0.5-1% concentration with fresh gas flow (100% oxygen) of 2 L/minute (low-flow sevoflurane anesthesia) with controlled ventilation. Injection of atropine 1 mg with neostigmine 2.5 mg to reverse the curarization effect of atracurium by titration method. The duration of operations in this group was from 1 up to 4 hours. While in group B, the same induction of anesthesia done as group A but, anesthesia was maintained by sevoflurane 1% to 1.5% concentration with fresh gas flow (100% oxygen) of 6-10 L/minute (high-flow sevoflurane anesthesia) with controlled ventilation. Injection of atropine 1 mg with neostigmine 2.5 mg to reverse the curarization effect of atracurium by titration method. The duration of operations in this group was also from 1 up to 4 hours. Preoperative, intraoperative and postoperative comparison of the following variables were done: 1- Heart rate, blood pressure (systolic, diastolic and mean) and Electrocardiogram (ECG). 2- The recovery characteristics (eye opening, squeeze fingers, spontaneous breathing, extubation, state name, nausea and vomiting) were observed and recorded. 3- Blood and urine samples were collected before anesthesia and at days 1, 3 and 5 postoperatively for serum creatinine, blood urea nitrogen, creatinine clearance, serum sodium and potassium, urine osmolality and urine glucose and protein. The results of this part showed that: 1- Sevoflurane caused insignificant decrease in heart rate, systolic, diastolic and mean blood pressure and may do prolongation of Q-T interval in ECG intraoperatively mainly in females. 2- Recovery after sevoflurane anesthesia was rapid especially with the short duration operations and in patients of group A (low-flow sevoflurane-anesthesia), postoperative nausea and vomiting in 5% from the total patients in both groups occurred. 3- There were non-significant changes in serum creatinine, blood urea nitrogen, creatinine clearance and serum sodium and potassium in both groups. 4- There were significant changes in urine osmolality, urine glucose and protein in the 1st and 3rd days postoperatively which returned to basal measurements in the 5th day ostoperatively. In the pharmacological experimental part, total 120 normal adult albino rats were used as an animal model. This part was divided into two studies: a) Studying the effects of graded concentrations of sevoflurane for variable durations. This study was containing 80 rats divided into 2 groups; each of 40 rats (divided into 3 subgroups; each of 10 rats) and a control group of 10 rats. b) Studying the effects of repeated administration of 2% of sevoflurane after 2 days. This study was containing 40 rats divided into 3 groups and a control group ; each group of 10 rats.