Effects of Probenecid on Renal Function in Surgical Patients Anesthetized with Low-flow Sevoflurane

2001 ◽  
Vol 94 (1) ◽  
pp. 21-31 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Hiroki Wada ◽  
Yumi Usui ◽  
Kohichiro Goto ◽  
Masuyuki Kanno ◽  
...  
Keyword(s):  
Urinary Excretion ◽  
Biochemical Markers ◽  
High Flow ◽  
Surgical Patients ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Significant Difference ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Background Dehydrofluorination of sevoflurane by carbon dioxide absorbents in anesthesia machines produces compound A, which is nephrotoxic in rats. Several clinical studies indicate that prolonged low-flow sevoflurane anesthesia is associated with an increased urinary excretion of biochemical markers, such as protein. Probenecid, a competitive inhibitor of organic anion transport, diminishes compound A nephrotoxicity in rats. The purpose of the present study was to examine the effects of low- and high-flow sevoflurane anesthesia on urinary excretion of biochemical markers in humans and to examine the effects of probenecid on urinary excretion of these markers. Methods Elective surgical patients (n = 64) were assigned to four groups (n = 16 each): low-flow sevoflurane plus probenecid (LSP), low-flow sevoflurane (LS), high-flow sevoflurane plus probenecid (HSP), and high-flow sevoflurane (HS). Probenecid (2.0 g) was administered orally 2 h before the induction of anesthesia in both the LSP and HSP groups. Nothing was administered orally 2 h before the induction of anesthesia in either the LS or HS groups. All patients underwent prolonged low-flow (1 l/min) or high-flow (6 l/min) sevoflurane anesthesia. Urinary excretion of protein, albumin, beta(2)-microglobulin, glucose, and N-acetyl-beta-d-glucosaminidase was measured for up to 7 days postoperatively. Results Sevoflurane doses were similar in all four groups. There were no differences in blood urea nitrogen, creatinine, or creatinine clearance among the four groups after anesthesia. Average values for urinary excretion of protein, beta(2)-microglobulin, and N-acetyl-beta-d-glucosaminidase in the LS group were significantly higher than those in the other groups (LSP, HSP, HS; P < 0.05). There was no significant difference between the LS and LSP groups in average values for urinary excretion of albumin and glucose, although there were significant differences between the LS and both high-flow sevoflurane groups (HSP, HS). Conclusions Low-flow sevoflurane, which produces a sevenfold higher compound A exposure than high-flow sevoflurane, resulted in significant increases of several biochemical markers in half of the patients. Probenecid appears to provide protection against these renal effects.

Effects of Sevoflurane and Isoflurane on Renal Function and on Possible Markers of Nephrotoxicity 

1998 ◽  
Vol 89 (2) ◽  
pp. 307-322 ◽  
Author(s):  
Hideyuki Higuchi ◽  
Shinji Sumita ◽  
Hiroki Wada ◽  
Tatsuya Ura ◽  
Takeshi Ikemoto ◽  
...  
Keyword(s):  
Renal Function ◽  
Renal Disease ◽  
Urinary Excretion ◽  
Creatinine Clearance ◽  
Blood Urea Nitrogen ◽  
High Flow ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Urea Nitrogen ◽  
Compound A

Background Low-flow sevoflurane anesthesia is associated with increasing circuit concentrations of compound A, which is nephrotoxic in rats, but the effect of compound A and low-flow sevoflurane anesthesia on renal function in humans is unclear. The authors compared the effects of high- and low-flow sevoflurane and isoflurane anesthesia on renal function and on several possible markers of nephrotoxicity in humans. Methods Forty-two patients without preexisting renal disease underwent either low-flow isoflurane (1 l/min, n = 14), low-flow sevoflurane (1 l/min, n 14), or high-flow sevoflurane (6 l/min, n = 14) anesthesia for body-surface-area surgery scheduled to last at least 4 h. Twenty-four-hour urinary excretion of N-acetyl-beta-glucosaminidase (NAG), beta2-microglobulin, protein, glucose, blood urea nitrogen (BUN), and serum creatinine concentrations were measured before and after anesthesia. Results There were no differences in blood urea nitrogen, creatinine, and creatinine clearance among the three groups after anesthesia. Increased urinary N-acetyl-beta-glucosaminidase excretions were seen in the low-flow and high-flow sevoflurane groups, but not in the low-flow isoflurane group (P < 0.01). Ten patients in the low-flow sevoflurane group had 24-h urinary excretion of protein that exceeded the normal ranges after anesthesia, but only one patient in the isoflurane and none in the high-flow sevoflurane groups had this. Conclusions Low-flow sevoflurane anesthesia was associated with mild and transient proteinuria. However, the observed proteinuria was not associated with any changes in blood urea nitrogen, creatinine, and creatinine clearance in these patients with no preexisting renal disease.

Compound A concentration and the temperature of CO2 absorbents during low-flow sevoflurane anesthesia in surgical patients

1995 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Masami Osawa ◽  
Tetsutaro Shinomura ◽  
Masahiro Murakawa ◽  
Kenjiro Mori
Keyword(s):  
Surgical Patients ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A

Effects of Low-flow Sevoflurane Anesthesia on Renal Function 

1997 ◽  
Vol 86 (6) ◽  
pp. 1231-1237 ◽  
Author(s):  
Hiromichi Bito ◽  
Yukako Ikeuchi ◽  
Kazuyuki Ikeda
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Gas Flow ◽  
High Flow ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Sevoflurane Group ◽  
Isoflurane Group ◽  
Alanine Aminopeptidase

Background The safety of low-flow sevoflurane anesthesia, during which CF2=C(CF3)-O-CH2F (compound A) is formed by sevoflurane degradation, in humans has been questioned because compound A is nephrotoxic in rats. Several reports have evaluated renal function after closed-circuit or low-flow sevoflurane anesthesia, using blood urea nitrogen (BUN) and serum creatinine as markers. However, these are not the more sensitive tests for detecting renal damage. This study assessed the effects of low-flow sevoflurane anesthesia on renal function using not only BUN and serum creatinine but also creatinine clearance and urinary excretion of kidney-specific enzymes, and it compared these values with those obtained in high-flow sevoflurane anesthesia and low-flow isoflurane anesthesia. Methods Forty-eight patients with gastric cancer undergoing gastrectomy were studied. Patients were randomized to receive sevoflurane anesthesia with fresh gas flow of 1 l/min (low-flow sevoflurane group; n = 16) or 6-10 l/min (high-flow sevoflurane group; n = 16) or isoflurane anesthesia with a fresh gas flow of 1 l/min (low-flow isoflurane group; n = 16). In all groups, the carrier gas was oxygen/nitrous oxide in the ratio adjusted to ensure a fractional concentration of oxygen in inspired gas (FiO2) of more than 0.3. Fresh Baralyme was used in the low-flow sevoflurane and low-flow isoflurane groups. Glass balls were used instead in the high-flow sevoflurane group, with the fresh gas flow rate adjusted to eliminate rebreathing. The compound A concentration was measured by gas chromatography. Gas samples taken from the inspiratory limb of the circle system at 1-h intervals were analyzed. Blood samples were obtained before and on days 1, 2, and 3 after anesthesia to measure BUN and serum creatinine. Twenty-four-hour urine samples were collected before anesthesia and for each 24-h period from 0 to 72 h after anesthesia to measure creatinine, N-acetyl-beta-D-glucosaminidase, and alanine aminopeptidase. Results The average inspired concentration of compound A was 20 +/- 7.8 ppm (mean +/- SD), and the average duration of exposure to this concentration was 6.11 +/- 1.77 h in the low-flow sevoflurane group. Postanesthesia BUN and serum creatinine concentrations decreased, creatinine clearance increased, and urinary N-acetyl-beta-D-glucosaminidase and alanine aminopeptidase excretion increased in all groups compared with preanesthesia values, but there were no significant differences between the low-flow sevoflurane, high-flow sevoflurane, and low-flow isoflurane groups for any renal function parameter at any time after anesthesia. Conclusions The only difference between the low-flow and high-flow sevoflurane groups was compound A formation, and postanesthesia laboratory data showed no significant effects of compound A formation during sevoflurane anesthesia on renal function. No significant effects on renal function were observed in either the low-flow or high-flow sevoflurane groups compared with the low-flow isoflurane group.

Compound A concentration and the temperature of CO2 absorbents during low-flow sevoflurane anesthesia in surgical patients

1995 ◽  
Vol 9 (1) ◽  
Author(s):  
Masami Osawa ◽  
Tetsutaro Shinomura ◽  
Masahiro Murakawa ◽  
Kenjiro Mori
Keyword(s):  
Surgical Patients ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Compound A

scholarly journals Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Cihan Doger ◽  
Kadriye Kahveci ◽  
Dilsen Ornek ◽  
Abdulkadir But ◽  
Mustafa Aksoy ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pulmonary Function ◽  
Pulmonary Function Tests ◽  
High Flow ◽  
Low Flow ◽  
Sevoflurane Anesthesia ◽  
Pulmonary Functions ◽  
Arterial Blood ◽  
Anesthesia Group ◽  
Significant Difference

Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy.Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H,n=30) and low-flow sevoflurane anesthesia group (Group L,n=30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery.Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times.Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy.

Effects of the Water Content of Soda Lime on Compound A Concentration in the Anesthesia Circuit in Sevoflurane Anesthesia 

1998 ◽  
Vol 88 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Hiromichi Bito ◽  
Yukako Ikeuchi ◽  
Kazuyuki Ikeda
Keyword(s):  
Gas Flow ◽  
Soda Lime ◽  
Absorption Capacity ◽  
Low Flow ◽  
Co2 Absorption ◽  
Sevoflurane Anesthesia ◽  
Compound A ◽  
Carbon Dioxide Co2 ◽  
End Tidal ◽  
Co2 Elimination

Background Sevoflurane anesthesia is usually performed with fresh gas flow rates greater than 2 l/min due to the toxicity of compound A in rats and limited clinical experience with sevoflurane in low-flow systems. However, to reduce costs, it would be useful to identify ways to reduce compound A concentrations in low-flow sevoflurane anesthesia. This goal of this study was to determine if compound A concentrations can be reduced by using soda lime with water added. Methods Low-flow sevoflurane anesthesia (fresh gas flow of 1 l/min) was performed in 37 patients using soda lime with water added (perhydrated soda lime) or standard soda lime as the carbon dioxide (CO2) absorbent. The soda lime was not changed between patients, but rather was used until CO2 rebreathing occurred. The perhydrated soda lime was prepared by spraying 100 ml distilled water onto 1 kg fresh soda lime, and water was added only when a new bag of soda lime was placed into the canister. Compound A concentrations in the circle system, soda lime temperatures, inspired and end-tidal CO2 and end-tidal sevoflurane concentrations, and CO2 elimination by the patient were measured during anesthesia. Results Compound A concentrations were significantly lower for the perhydrated soda lime (1.9 +/- 1.8 ppm; means +/- SD) than for the standard soda lime (13.9 +/- 8.2 ppm). No differences were seen between the two types of soda lime with regard to the temperature of the soda lime, end-tidal sevoflurane concentrations, or CO2 elimination. Compound A concentration decreased with the total time of soda lime use for both types of soda lime. The CO2 absorption capacity was significantly less for perhydrated soda lime than for standard soda lime. Conclusions Compound A concentrations in the circuit can be reduced by using soda lime with water added. The CO2 absorption capacity of the soda lime is reduced by adding water to it, but this should not be clinically significant.

High flow compression molding for recycling discontinuous long fiber thermoplastic composites

2020 ◽  
Vol 54 (23) ◽  
pp. 3343-3350
Author(s):  
Éric Léger ◽  
Benoit Landry ◽  
Gabriel LaPlante
Keyword(s):  
Mechanical Properties ◽  
Tensile Strength ◽  
Compression Molding ◽  
High Flow ◽  
Low Flow ◽  
Thermoplastic Composites ◽  
Direction Parallel ◽  
Significant Difference ◽  
Long Fiber Thermoplastic ◽  
Flow Compression

An investigation into high flow compression molding for recycling thermoplastic discontinuous long fiber composites is presented. High flow recycled panels and conventional low flow baseline panels were produced with a large rectangular (2:1 aspect ratio) mold. Flow was induced in the recycled panels by stacking cut sections of conventionally produced baseline panels in the center of the mold cavity, representing 25% initial coverage. High flow compression molded panels were found to exhibit significantly higher than baseline tensile strength (+50%) and modulus (+31%) when tested in the direction parallel to flow. When tested in the direction perpendicular to flow, the opposite effect was found, with reductions in tensile strength (−42%) and modulus (−37%). However, when the average results of both directions are compared to baseline, no significant difference was found between the recycled and baseline panels. This severe anisotropic redistribution of mechanical properties suggests chip orientation is affected by flow. Additionally, micrographic analysis revealed that high flow molding induces intra-ply chip shearing and a reduction in resin rich regions within panels. Baseline panels also exhibited in-plane anisotropy, despite initial random distribution of chips and no or near no flow induced during molding. In this case, mechanical properties favored the direction perpendicular to that of the recycled panels.

Multiple myeloma: VMCP/VBAP alternating combination chemotherapy is not superior to melphalan and prednisone even in high-risk patients.

1991 ◽  
Vol 9 (3) ◽  
pp. 444-448 ◽  
Author(s):  
M Boccadoro ◽  
F Marmont ◽  
M Tribalto ◽  
G Avvisati ◽  
A Andriani ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Median Overall Survival ◽  
Cell Labeling ◽  
Induction Treatment ◽  
Treatment Groups ◽  
Significant Difference ◽  
Risk Patients ◽  
Beta 2 ◽  
Beta 2 Microglobulin

The efficacy of alternating vincristine, melphalan (M), cyclophosphamide, prednisone/vincristine, carmustine, doxorubicin, and prednisone (VMCP/VBAP) polychemotherapy was compared with the M and prednisone (MP) regimen as induction treatment in multiple myeloma (MM). Three hundred four MM patients entered this study between March 1983 and July 1986; the analysis was performed in December 1989. The treatment groups did not show significant differences with respect to major prognostic factors. Median overall survival was 33.8 months. In the VMCP/VBAP and MP arms, after 12 induction chemotherapy cycles, 59.0% and 47.3% (P less than .068) of the patients achieved an M component reduction greater than 50%. No significant difference was observed in the two treatment arms in terms of remission duration (21.3 v 19.6 months, P less than .66) and survival (31.6 v 37.0 months, P less than .28). Patients younger than 65 years did not show any advantage from the alternating polychemotherapy. At diagnosis, the plasma cell labeling index (LI) and serum beta-2 microglobulin (beta 2-m) were evaluated in 173 and 183 patients, respectively. A significantly reduced survival was observed for patients with LI greater than or equal to 2% (16.4 months) or beta 2-m greater than or equal to 6 mg/L (20.4 months). Even in these poor-risk subgroups, VMCP/VBAP was not superior to MP.

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