Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.11.004
Brazilian Journal of Anesthesiology
Original Investigation

Minimal fresh gas flow sevoflurane anesthesia and postoperative acute kidney injury in on-pump cardiac surgery: a randomized comparative trial

Anestesia com fluxo mínimo de gás fresco com sevoflurano e lesão renal aguda pós-operatória em cirurgia cardíaca com CEC: um estudo comparativo randomizado

Eric Benedet Lineburger, Norma Sueli Pinheiro Módolo, Leandro Gobbo Braz, Paulo do Nascimento Junior

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Abstract

Background
: Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal fresh gas flow (FGF) and is nephrotoxic in animals. No conclusive data has shown increased risk in humans. The aim of this study was to investigate if minimal FGF promotes an increase in the incidence of acute kidney injury (AKI) when compared to high FGF in patients undergoing on-pump cardiac surgery under sevoflurane anesthesia.

Methods
: Two hundred and four adult patients scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF (0.5 L.min−1) or high FGF (2.0 L.min−1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO (Kidney Disease Improving Global Outcomes) guideline to define postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge.

Results
: Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (p = 0.774). Twenty days after discharge, 11 patients (6.1%) still had CSA-AKI and 120 days after discharge only 2 patients (1.6%) still had CSA-AKI.

Conclusions
: When compared to high FGF, minimal FGF sevoflurane anesthesia during on-pump cardiac surgery is not associated with increased risk of postoperative AKI in this population at high risk for renal injury.

Keywords

Acute kidney injury;  Sevoflurane;  Anesthesia;  Occupational health

Resumo

Introdução

O composto A é gerado pelo sevoflurano quando reage com absorvedores de dióxido de carbono com bases fortes em fluxo mínimo de gás fresco (FGF) e é nefrotóxico em animais. Nenhum dado conclusivo mostrou risco aumentado em humanos. O objetivo deste estudo foi investigar se o FGF mínimo promove um aumento na incidência de lesão renal aguda (LRA) quando comparado ao FGF alto em pacientes submetidos à cirurgia cardíaca com CEC sob anestesia com sevoflurano.

Métodos

Duzentos e quatro pacientes adultos agendados para cirurgia cardíaca com CEC sob anestesia com sevoflurano foram alocados aleatoriamente em dois grupos diferenciados por FGF: FGF mínimo (0,5 L.min−1) ou FGF alto (2,0 L.min−1). A creatinina basal medida antes da cirurgia foi comparada diariamente com os valores dosados nos primeiros cinco dias de pós-operatório, e o débito urinário de 24 horas foi monitorado, de acordo com a diretriz KDIGO (Kidney Disease Improving Global Outcomes) para definir lesão renal aguda associada à cirurgia cardíaca pós-operatória (LRA-PCC). As dosagens de creatinina também foram obtidas 20 e 120 dias após a alta hospitalar.

Resultados

LRA pós-operatória ocorreu em 55 pacientes, 26 pacientes (29,5%) no grupo FGF mínimo e 29 pacientes (31,5%) no grupo FGF alto (p = 0,774). Vinte dias após a alta, 11 pacientes (6,1%) ainda apresentavam LRA-PCC e 120 dias após a alta apenas 2 pacientes (1,6%) ainda apresentavam LRA-PCC.

Conclusão

Quando comparada ao FGF alto, a anestesia mínima de FGF com sevoflurano durante cirurgia cardíaca com CEC não está associada a risco aumentado de LRA pós-operatória nessa população com alto risco de lesão renal.

Palavras-chave

Lesão renal aguda; Sevoflurano; Anestesia; Saúde Ocupacional

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