Summary
The intermittent appearance of clinical reports associating methoxyflurane with renal toxicity indicated the necessity of considering the manner of drug usage most likely to avoid such sequelae. Evidence is presented that methoxyflurane may have a depressant effect on adenosine triphosphatase systems in the kidney. Evidence is presented that very light methoxyflurane anaesthesia reduces inulin andpah clearances in the intact dog. These and other reports indicate that undesirable effects on renal function may persist into the postoperative period if deep methoxyflurane is employed. The clinical reports of renal toxicity are briefly reviewed and it is noted that the surgery performed was usually of a major nature, often prolonged, and considerable reliance seems to have been placed on methoxyflurane as a muscle relaxing drug. It appears reasonable to assume that other toxic effects attributed to methoxyflurane may be dose related, particularly in the absence of knowledge concerning the significance of methoxyflurane metabolites. It is suggested that only minimal quantities of methoxyflurane be used to maintain anaesthesia and if in addition muscle relaxation or abolition of upper respiratory tract reflexes is required then reliance should be placed primarily on neuromuscular blockers and analgesics.
Résumé
L’apparition occasionnelle de rapports cliniques associant le méthoxyflurane à une toxicité rénale indique la nécessité d’étudier le mode d’emploi qui serait le plus susceptible d’éviter de telles séquelles. Certains prétendent que le méthoxyflurane exercerait un effet dépresseur sur les systèmes à adénosine triphosphatase du rein. On prétend également qu’une anesthésie très légère au méthoxyflurane diminue la clearance de l’inuline etpah chez le chien. Ces rapports laissent entendre que, au cours de la période post-opératoire, ces effets indésirables sur la fonction rénale pourraient continuer à exister si l’on a administré une anesthésie profonde au méthoxyflurane. Nous faisons une brève revue des rapports sur la toxicité rénale et nous observons que, bien souvent, la chirurgie était importante, prolongée et que l’on comptait beaucoup sur le méthoxyflurane comme myorésolutif. Il semble juste d’assumer que d’autres effets toxiques attribués au méthoxyflurane seraient proportionnels à la dose donnée, particulièrement si l’on ignore la signification des métabolites du méthoxyflurane. Nous suggérons d’utiliser seulement des quantités minimes de méthoxyflurane pour maintenir l’anesthésie et s’il faut, de plus, un relachement musculaire ou l’abolition des réflexes des voies respiratoires supérieures, il est à conseiller alors de compter surtout sur les myorésolutifs et les analgésiques.
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McIntyre, J.W.R., Russell, J.C. Renal function and methoxyflurane anaesthesia. Canad. Anaesth. Soc. J. 18, 131–136 (1971). https://doi.org/10.1007/BF03025441
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DOI: https://doi.org/10.1007/BF03025441