Abstract
BackgroundThe choice of anaesthetic may influence regulation of renal perfusion and function. We investigated renal function in patients anaesthetised with propofol or sevoflurane before surgery and postoperatively. MethodsPatients with ASA physical status 1–2 planned for spinal surgery were randomised to propofol or sevoflurane anaesthesia. Blood and urine were collected before anaesthesia, during anaesthesia (before surgery), during postoperative care, and the day after surgery. ResultsTwenty-seven patients completed the study protocol (average age, 51 yr; average BMI, 28 kg m−2) and 11 were women. Urine output and sodium excretion were lower during sevoflurane anaesthesia (n=14) than during propofol anaesthesia (n=13) (0.3 vs 1.1 ml kg−1 h−1 [P=0.01] and 2.6 vs 6.0 mmol h−1 [P=0.04], respectively). Urinary potassium excretion was lower during anaesthesia than after, without intergroup difference (2.3 vs 5.7 mmol h−1, P<0.001). Sevoflurane anaesthesia increased plasma renin compared with baseline (138 vs 23 mIU L−1, P<0.001) and propofol anaesthesia (138 vs 27 mIU L−1, P=0.008). Plasma arginine–vasopressin did not change significantly during anaesthesia, but was elevated postoperatively compared with baseline irrespective of anaesthetic (21 vs 12 ng L−1, P=0.02). Sevoflurane caused higher postoperative plasma creatinine than propofol (83 vs 66 mmol L−1, P=0.01). Kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin did not change significantly in either group. ConclusionsSevoflurane anaesthesia reduced urine output and sodium excretion and increased plasma renin compared with propofol anaesthesia. The impact of this on acute kidney injury and fluid resuscitation during surgery warrants further investigation. Clinical trial registrationEudraCT: 2017-001646-10; Clinicaltrials.gov: NCT0333680.
Highlights
Urine output and sodium excretion were lower during sevoflurane anaesthesia (n1⁄414) than during propofol anaesthesia (n1⁄413) (0.3 vs 1.1 ml kgÀ1 hÀ1 [P1⁄40.01] and 2.6 vs 6.0 mmol hÀ1 [P1⁄40.04], respectively)
The effects of propofol or sevoflurane anaesthesia on renal function and water-restoring hormones were investigated in a cohort without major comorbidities
We found that sevoflurane anaesthesia resulted in lower urine output and sodium excretion and higher plasma renin during anaesthesia compared with propofol anaesthesia, as hypothesised
Summary
We investigated renal function in patients anaesthetised with propofol or sevoflurane before surgery and postoperatively. Urine output and sodium excretion were lower during sevoflurane anaesthesia (n1⁄414) than during propofol anaesthesia (n1⁄413) (0.3 vs 1.1 ml kgÀ1 hÀ1 [P1⁄40.01] and 2.6 vs 6.0 mmol hÀ1 [P1⁄40.04], respectively). Conclusions: Sevoflurane anaesthesia reduced urine output and sodium excretion and increased plasma renin compared with propofol anaesthesia. The impact of this on acute kidney injury and fluid resuscitation during surgery warrants further investigation.
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