Sevoflurane
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Renal failure: case report A 34-year-old man developed renal failure during sedation therapy with sevoflurane. The man was admitted to the hospital after a road traffic accident. Due to accident, he had multiple traumas, right rib fractures, serious pelvic fracture and a fracture of the proximal tibia. Additionally, he had an occipital skull fracture and a subarachnoid haemorrhage. He was then shifted to the ICU. On day 3 after the admission, he underwent pelvic arterial embolisation for haemodynamic instability under the continuous IV sedation therapy and mechanical ventilation. At that time, he received a continuous infusion of propofol, ketamine, midazolam and sufentanil. On day 6, he underwent pelvic arterial embolisation for the second time. As he had +2 score on the Richmond agitation sedation scale, he received inhalational sedation therapy with sevoflurane. Sevoflurane was administered through the Mirus system along with continuous end-tidal gas monitoring. The age-corrected minimum alveolar concentration (MAC) of sevoflurane was maintained between 0.5 and 1.3. The total dose of sevoflurane was 25 MAC hours. Following sevoflurane administration, he developed polyuria and hypernatraemia. Polyuria was highest on day 8, whereas hypernatraemia was highest on day 10. Additionally, he had elevated blood urea nitrogen, serum creatinine and plasma osmolality. On the contrary, he had abnormally low urinary osmolality. His serum inorganic fluoride level was measured as 137.9 mmol/L along with a high urinary excretion of inorganic fluoride per gram of creatine. Based on the aforementioned clinical presentation, he was diagnosed with renal failure due to sevoflurane. Prior to the initiation of sevoflurane, he had no evidence of renal failure. Thereafter, the man’s sedation therapy with sevoflurane was switched to IV infusion of midazolam and sufentanil. His organ failure assessment score improved and all symptoms eventually resolved. After 42 days of the ICU stay, he was discharged in a fully recovered condition. Author comment: "In conclusion, this clinical case shows that sedation with sevoflurane can be associated with renal dysfunction in a trauma patient." Maussion E, et al. Renal dysfunction during sevoflurane sedation in the ICU: A case report. European Journal of Anaesthesiology 36: 377-379, No. 5, May 2019. Available from: URL: http://doi.org/10.1097/EJA.0000000000000836 803444186 France
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Reactions 4 Jan 2020 No. 1785
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