Renal function in surgical patients after administration of low-flow sevoflurane and amikacin

Abstract

Purpose. Compound A, a degradation product of sevoflurane, is nephrotoxic in rats, while aminoglycosides induce nephrotoxic injury in humans. Combining an aminoglycoside with a known nephrotoxin can enhance nephrotoxicity. We investigated the effects of aminoglycosides on renal function in surgical patients anesthetized with low-flow sevoflurane.

Methods. We compared the urinary excretion of several biochemical markers (such as total protein, albumin, β₂-microglobulin, glucose, and N-acetyl-β-glucosaminidase [NAG]) in an amikacin group (n = 18) and a control group (n = 19) of surgical patients anesthetized with low-flow anesthesia (1 l·min⁻¹) with sevoflurane. All patients received cefotiam as an antibiotic perioperatively. In addition, the amikacin group received amikacin, an aminoglycoside, given intravenously twice a day (400 mg per day) from immediately after the induction of anesthesia to day 2 after anesthesia.

Results. Duration of anesthesia and mean compound A concentration were 5.2 ± 1.4 h and 27.2 ± 8.7 ppm (mean ± SD) in the amikacin group, and 5.1 ± 1.7 h and 27.1 ± 7.8 ppm in the control group respectively (P > 0.05). The two groups did not differ in clinical laboratory baseline values (blood urea nitrogen and serum creatinine concentration). There were no significant differences between the groups in either the maximum or the average values for the urinary excretion of biochemical markers after anesthesia.

Conclusion. Our study demonstrates that there is no synergic effect of compound A and amikacin on nephrotoxicity in humans.