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Methoxyflurane revisited: tale of an anesthetic from cradle to grave

Richard I Mazze1

  • 1Stanford University School of Medicine, and Veterans Administration Palo Alto Health Care System, 300 Pasteur Drive, Stanford, CA 94305, USA. mazze@stanford.edu

Anesthesiology
|September 29, 2006
PubMed

Insights

Methoxyflurane anesthesia can cause kidney damage. Elevated inorganic fluoride and oxalic acid levels in patients indicate methoxyflurane metabolism is linked to this renal dysfunction.

Area of Science:

  • Anesthesiology
  • Nephrology
  • Toxicology

Background:

  • Methoxyflurane is an inhalational anesthetic agent.
  • Renal dysfunction is a potential adverse effect associated with methoxyflurane anesthesia.
  • The metabolic pathways and toxic byproducts of methoxyflurane were not fully understood.

Discussion:

  • Serum inorganic fluoride and urinary inorganic fluoride excretion were significantly elevated in patients with methoxyflurane-induced renal dysfunction.
  • Patients with clinically evident renal dysfunction showed higher peak serum inorganic fluoride levels and oxalic acid excretion compared to those with only laboratory abnormalities.

Key Insights:

  • Inorganic fluoride and oxalic acid are products of methoxyflurane metabolism.
  • Inorganic fluoride is implicated as the causative agent in methoxyflurane-induced renal dysfunction.
  • Halothane anesthesia did not result in similar elevations, supporting methoxyflurane as the source.

Outlook:

  • Further research into the metabolic pathways of methoxyflurane is warranted.
  • Understanding methoxyflurane's nephrotoxic mechanisms can inform safer anesthetic practices.
  • Development of strategies to mitigate methoxyflurane-induced renal injury may be possible.

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