Impact of intravenous propofol and volatile sevoflurane anesthesia on renal function in an experimental pig model of hemorrhage-induced acute kidney injury

Abstract

Volatile anesthesia has recently been associated with an independent stimulatory effect on the renal sympathetic nervous system, which causes a reduction in renal blood flow (RBF) and renal excretory function. This anesthetic modality could therefore be a significant contributor to renal injury in the surgical setting. We therefore aimed to investigate the role of anesthetic modality on renal function in an experimental pig model and hypothesized that volatile anesthesia aggravates renal recovery after hemorrhage and resuscitation.Pigs (30±2 kg, 1:1 male-female) were anesthetized with either propofol-fentanyl (P) or sevoflurane-fentanyl (S) and surgically prepared. Renal function and hemodynamics were monitored during a baseline period, a 30-min hemorrhage period, and after 1h recovery after fluid resuscitation with the lost volume (1:1 blood-Ringers Acetate).During baseline, RBF and oxygen delivery (DO 2 ) was significantly lower in the pigs with sevoflurane than propofol anesthesia (RBF P: 191±40 vs S: 130±30 ml min -1 , p<0.001; DO 2 P: 31±5 vs S: 15±3 ml min -1 , p<0.001). Renal vascular resistance (RVR) was also higher in the sevoflurane anesthetized pigs during baseline (P: 0.2±0.05 vs S: 0.5±0.1, p=0.002). There was no statistically different effect of hemorrhage on renal function or hemodynamics between the two anesthetic modalities. Moreover, hemorrhage did not significantly reduce diuresis (P: decreased by 0.7±0.4 ml min -1 , p=0.08; S: decreased by 0.4±0.4 ml min -1 , p=0.38). After resuscitation, both groups recovered similarly regarding hemodynamics and renal function however, creatinine clearance was still significantly decreased in the sevoflurane group compared with baseline (decreased by 37±31 ml min -1 , p=0.02) but recovered in the propofol group. Regarding renal excretory function, no significant differences between the anesthetic modalities were revealed during the experimental protocol.Sevoflurane anesthesia reduced RBF and DO 2 and increased RVR. After hemorrhage and resuscitation, creatinine clearance was significantly lower than before the hemorrhage in the sevoflurane group. Even though this reduction in renal perfusion is in alignment with an increase in renal sympathetic nerve activity, no significant impact of anesthetic modality was seen on renal excretory function. However, sevoflurane anesthesia still has an effect on RBF and creatinine clearance. The choice of anesthesia could therefore effect the incidence of acute kidney injury in patients with higher susceptibility for acute kidney injury. Funding sources: Magnus Bergvall Foundation (2017-02295) and Swedish Research Council (2014-02569 and 2014-07606). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.