الفهرس Only 14 pages are availabe for public view
 |  | from | 263 |  |  |
| | | from | 263 | | |
Abstract
Organ toxicity is rare in patients exposed to inhaled anesthetics, but
it may result in severe, potentially life threatening multiple organ
damage and so the means by which inhaled anesthetics causes organ
toxicity in experimental animals and man have been investigated
intensively.
Sevoflurane is characterized by pleasant non-irritant odor allow
inhalational induction of anesthesia, cardiovascular stability, safety in
ischemic heart disease, minimal respiratory depression does not affect
hepatic perfusion, oxygenation or metabolic function and not potentially
hepatotoxic as halothane minimal effect on cerebral blood flow and it
has relaxant effect and augments the action of neuromuscular blocking
agents.
There is controversy about the effect of sevoflurane on the liver and
kidney as its organic metabolite give heoxfluoroisopropanol (HFIP) and
liberate inorganic fluoride which may reach the proposed toxic threshold
of 50 μmol/L in some cases but there is no reports of hepatic or renal
troubles caused by HFIP and fluoride produced by its metabolism. Also,
there is a controversy about safety of sevoflurane due to its degradation
to compound A which is a potential nephrotoxic in rats probably through
the β-lyase pathway).
Our study was performed on 120 patients. Induction was performed
using sodium thiopental, fentanyl and atracurium. Anesthesia is the
٢٠٤
maintained by either sevoflurane or isoflurane in a mixture of nitrous
oxygen 50:50. The flow rate was more than 4 L/min. At the end of
surgery, the anesthesia was terminated off and we assess the effect of
both sevoflurane and isoflurane on hepatic and renal function for normal
as well as moderate stable hepatic or renal insufficiency patients
preoperative, intraoperative and 3 days postoperative.
We found that there is no significant effect on liver function tests as
SGOT, SGPT, total serum proteins, serum albumin, A/G ratio, total
serum bilirubin and prothrombin time). Also there is no significant effect
on blood urea and serum creatinine preoperative, intraoperative and 3
days postoperative.
We found that there are no significant changes as regard
hemodynamic or serum cortisol level in both groups (sevoflurane and
isoflurane) when compared to each other or to the baseline (preoperative
value).
We can conclude according to out study and many other studies that
there is no significant difference in hepatic and renal outcome after
anesthesia using sevoflurane or isoflurane and there is no evidence of
hepatic or renal impairment in both groups even in case of stable hepatic
or renal insufficiency.