The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomize
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REVIEW ARTICLE/BRIEF REVIEW
The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomizedcontrolled trials Impact d’une anesthe´sie au se´voflurane sur la fonction re´nale postope´ratoire : revue syste´matique et me´ta-analyse des e´tudes randomise´es controˆle´es Rakesh V. Sondekoppam, MBBS, MD . Karim H. Narsingani, MSc . Trent A. Schimmel, BSc . ¨ zelsel, MD, DESA Brie M. McConnell, MLIS . Karen Buro, Dr rer nat . Timur J.-P. O Received: 21 December 2019 / Revised: 5 May 2020 / Accepted: 11 May 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Renal damage secondary to fluoride ions and compound A (CpdA) after sevoflurane anesthesia remains unclear. For safety reasons, some countries still recommend minimum fresh-gas flows (FGFs) with sevoflurane. We review the evidence regarding the intraoperative use of sevoflurane for anesthesia maintenance and postoperative renal function compared with other anesthetic agents used for anesthetic maintenance. Secondarily, we examine the effects of peak
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01791-5) contains supplementary material, which is available to authorized users. R. V. Sondekoppam, MBBS, MD Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA K. H. Narsingani, MSc T. A. Schimmel, BSc University of Alberta Medical School, Edmonton, AB, Canada B. M. McConnell, MLIS Schulich School of Medicine and Dentistry, Western University, London, ON, Canada K. Buro, Dr rer nat Department of Mathematics and Statistics, MacEwan University, Edmonton, AB, Canada ¨ zelsel, MD, DESA (&) T. J.-P. O Department of Anesthesia and Pain Medicine, University of Alberta, 2-150 Clinical Sciences Building (CSB), 8440 112 St NW, Edmonton, AB T6G 2G3, Canada e-mail: [email protected]
plasma fluoride and CpdA levels and the effect of FGF and duration of anesthesia on these parameters. Source The databases of MEDLINE (OVID and Pubmed), EMBASE, the Cochrane Library, Health Technology Assessment Database, CINAHL, and Web of Science were searched from inception until 23 April 2020 to identify randomized-controlled trials (RCTs) in humans utilizing sevoflurane or an alternative anesthetic for anesthesia maintenance with subsequent measurements of renal function. Two different paired reviewers independently selected the studies and extracted data. The quality of the evidence was appraised using GRADE recommendations. Principal findings Of 3,766 publications screened, 41 RCTs in human patients were identified. There was no difference between creatinine at 24 hr (21 studies; n = 1,529), or creatinine clearance (CCR) at 24 hr (12 studies; n = 728) in the sevoflurane vs alternative anesthetic groups. Peak fluoride and fluoride measured at 24 hr were higher with sevoflurane compared with other inhaled anesthetics. Subgroup analyses for sevoflurane usage in various contexts showed no significant difference between sevoflurane a
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