Sevoflurane (CH2F-O-CH(CF3)2) is a fluorinated derivative of ethyl isopropyl ether. Sevoflurane has a blood/gas partition coefficient of 0.60 that allows a rapid induction and emergence of anesthesia. There are several reports that the
hemodynamic
changes are almost similar to halothane at equipotent dose. But sevoflurane is metabolized to inorganic fluoride known as the etiologic agent of anesthetic nephrotoxicity, more than halothane and isoflurane.
Acute renal failure develops in approximately 11% of burned patients. It is not known whether sevoflurane anesthesia intensifies the renal dysfunction in the early stage, and sevoflurane biotransformation increases in major burn patients,
producing
higher inorganic plasma fluoride level than non-burn patients, thus increasing the potential for fluoride-induced renal dysfunction. So we studied sevoflurane in the major burn patients. In this investigation we measured the concentrations of
serum
and
urine inorganic fluoride ions before, during and after sevoflurane anesthesia, respectively, with urine volume and osmolality in the major burn patients (n=8). The peak serum fluoride concentration was 30.99 ㎛ol/L, 4 hours after anesthesia and
then the
concentration of serum inorganic fluoride decreased quickly. Peak urinary (fluoride concentration was 123.7.73±134.27 ㎛ol/L, 8 hours after cessation of) sevoflurane, and its concentration was less than 100㎛ol/L on the fourth postoperative day.
No
evidence of abonomal hepatorenal function occurred on the first postoperative day.
In conclusion, anesthesia with sevoflurane is safe without significant adverse effects int he major burn patients. Although sevoflurane delivery to major burn patients produced a mean peak serum fluoride level of 30.99㎛ol/L, no evidence of
abnormal
renal function occurred in any of the patients in the postoperative period.
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