[Kidney function in test subjects: published results and clinical relevance]

Sevoflurane degrades in CO2 absorbents to produce compound A, which may have hepatotoxic potential in humans. Several recent studies in human volunteers have been performed to evaluate this potential. Three studies have evaluated sevoflurane administered to volunteers using a 3% concentration for 8 h duration at approximately 2 L/min flow rate. The initial investigation found high excretion of protein, glucose and renal tubular enzymes in the urine of the volunteers receiving sevoflurane. Subsequent investigations using identical protocols found more minor or absent changes in excretion of these markers. One additional investigation in volunteers studied 3% sevoflurane anesthesia for 4 h duration using a low-flow (1 L/min) technique. No significant excretion of protein, glucose or renal enzymes was observed. Application of these results to clinical practice must be interpreted in light of the experimental nature of the anesthetic administration. Although some controversy remains, these data, combined with results of recent studies in surgical patients, suggest that renal function following modest duration low-flow sevoflurane anesthesia is similar to that following isoflurane anesthesia.