Abstract
Blood serum inorganic fluoride was measured serially with a fluoride-specific electrode before, during and after major abdominal operations performed under anaesthesia with enflurane (Ethrane) in 66 patients and with isoflurane (Forane) in 189 patients. The fluoride levels observed indicated that enflurane is probably metabolically biodegraded slightly, while isoflurane is free from enzymatic degradation that releases fluoride ion into the blood. With these anaesthetics, the highest blood levels of serum inorganic fluoride observed were lower than those seen with well-controlled administration of methoxyflurane. Nevertheless, we recommend that if one of these new agents is chosen for a prolonged major operation it should be used only after induction with another anaesthetic (such as thiopentone) and a non-depolarizing muscle relaxant; maintenance may then be carried on with approximately 60 per cent nitrous oxide, 40 per cent oxygen, and 1 per cent or less of one of these agents, as was done in this study. There would then be only a very remote possibility that toxicity could develop through accumulation of fluoride ion in the blood and, subsequently, in the kidney. Administration of enflurane at more than biweekly intervals is not recommended.
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