Sevoflurane and Postoperative Renal Function

Abstract

In Response: We thank both Drs. DeSouza and Gold, and Dr. Epstein for their letters in reference to our article. These letters question the relationship of our paper to the multicenter study. In reply to the question of whether renal function was only confined to our site, we do not have an answer for this, as we only have information concerning our site. One must remember ours was one of the few sites that was involved in sampling for fluoride ion. Other sites did not have the opportunity to examine the relationship. As previously stated in our article, the mean value for blood urea nitrogen (BUN) and creatinine were not different between the two groups. We agree with Drs. DeSouza and Gold that the BUN and creatinine are not specific indices of renal function. We have stated this in our discussion and have recommended that further studies are indicated. We agree with Dr. Epstein and realize that other issues, such as glucose and furosemide administration, may have contributed to the increased BUN and creatinine levels. Again, we refer to the conclusion and discussion of our article. Intravascular fluid volume was maintained according to protocol by the administration of blood and crystalloid to maintain an adequate urinary output. The last sentence of our publication does not emphatically state that sevoflurane causes renal toxicity, but rather suggests this as a possibility. We understand that this is a matter of semantics; however, once again, we emphasize that further investigations are indicated, particularly in the ASA physical status III population undergoing major abdominal surgery. We thank both Drs. DeSouza and Gold as well as Dr. Epstein for their constructive comments. Michael E. Goldberg, MD Department of Anesthesiology; University of Medicine and Dentistry of New Jersey; Robert Wood Johnson Medical School at Camden; Camden, NJ 08103 Joaquin Cantillo, MD Denis Vekeman, CRNA Department of Anesthesiology; Cooper Hospital/University Medical Center; Camden, NJ 08103