Sevoflurane metabolite production in a small cohort of coronary artery bypass graft surgery patients.

Objective: To determine hepatic and renal effects of hexafluoroisopropanol in patients undergoing coronary artery bypass graft surgery under sevoflurane anesthesia.

Design: Prospective, clinical comparison.

Setting: University hospital.

Participants: Adult patients scheduled for coronary artery bypass graft surgery (n = 56) were divided into 3 groups according to renal function: group 1, patients with normal renal function (plasma creatinine <1.7 mg/dL), subdivided into 2 groups (group 1a and group 1b), and group 2, patients with impaired renal function (plasma creatinine > or = 1.7 mg/dL).

Interventions: Anesthesia was maintained with fentanyl, 20 microg/kg, and sevoflurane. In group 1a and group 2, sevoflurane dosage was 0.5 minimum alveolar concentration (MAC). In group 1b, it was 1.0 MAC of sevoflurane. During cardiopulmonary bypass, the same concentration of sevoflurane was given through a membrane oxygenator.

Measurements And Main Results: Serum hexafluoroisopropanol concentration was measured before induction of anesthesia, at the initiation of cardiopulmonary bypass, at the release of the aortic cross-clamp, at the end of cardiopulmonary bypass, at the end of surgery, and on the 1st postoperative day. Blood urea nitrogen, creatinine, 24-hour urinary output, aspartate aminotransferase, alanine aminotransferase, and total bilirubin were measured at preoperative evaluation, at the end of surgery, and on the 1st and 3rd postoperative days. The levels of hexafluoroisopropanol increased and peaked on the 1st postoperative day. Laboratory values showed no significant differences among all groups.

Conclusion: The serum level of hexafluoroisopropanol after 0.5 MAC of sevoflurane anesthesia does not aggravate hepatic and renal functions.