Plasma fluoride concentrations during and after prolonged anesthesia: a comparison of halothane and isoflurane

Serum inorganic fluoride concentrations were studied in 19 adult patients undergoing prolonged head and neck surgery with either halothane or isoflurane anesthesia (mean 19.5 and 19.2 MAC-hours, respectively). In the group of nine patients anesthetized with isoflurane, plasma inorganic fluoride increased from a mean concentration of 3.5 mumols/L (baseline) to a peak of 43.2 mumols/L. Forty percent of the patients in the isoflurane group had peak plasma inorganic fluoride concentrations of more than 50 mumol/L. In the group that received halothane, plasma inorganic fluoride concentrations increased from a mean of 3.8 mumols/L to a peak of 12.6 mumols/L. Despite similar exposures to both anesthetics, the differences in serum inorganic fluoride concentrations between the two groups were significant at 10, 24, and 48 h after induction of anesthesia (P = 0.035, P = 0.003, and P = 0.003, respectively). Serum electrolyte, urea, and creatinine concentrations and urine output rates during and after surgery were similar in both groups. We conclude that, after anesthesia of up to 20 MAC-hours, metabolism of isoflurane to inorganic fluoride may be of a greater magnitude than has previously been realized. Although no clinical or biochemical evidence was found to suggest postoperative renal dysfunction, we recommend caution using isoflurane when prolonged anesthesia and surgery are planned.