Der Anaesthesist
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The cardiovascular effects of sevoflurane are similar to those of isoflurane with some minor exceptions. In contrast to isoflurane and particularly to desflurane, sevoflurane has not been associated with increases in heart rate in healthy volunteers and in patients. ⋯ In several multi-center studies of patients with coronary artery disease or at high risk for coronary artery disease receiving either sevoflurane or isoflurane for either cardiac or non-cardiac surgery, the incidence of myocardial ischemia and infarction did not differ between treatment groups. In both human and animal models, sevoflurane preserves cerebral blood flow and reduces cerebral metabolic rate, much like isoflurane.
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The total costs for a department of anaesthesia amount to a fraction of the total hospital budget that is proportional to the overall number of hospital departments; this means anaesthetic departments are in general not cost drivers. In the analysis of perioperative costs, anaesthesia accounts for about 10-15% of the total costs for the complete hospital stay, the exact proportion depending on the type of surgery. In the analysis of costs for the intraoperative period alone anaesthesia personnel contributes about 20%, and material costs about 10% of the total costs, while inhalational agents account for less than 1%. ⋯ The question of whether these effects and side effects translate into cost differences between agents depends largely on local factors, e.g., patient case mix, staffing, policy of discharge from the postanaesthetic care unit, and many others. We conclude that volatile anaesthetics account for only a minor portion of the budgets in the anaesthesia department and the hospital overall. The higher market price for the new agents that result in higher costs per MAC-hour may be compensated for by the economic impact of the fewer side effects and the shorter postanaesthesia stay in the hospital.
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Sevoflurane degrades in CO2 absorbents to produce compound A, which may have hepatotoxic potential in humans. Several recent studies in human volunteers have been performed to evaluate this potential. Three studies have evaluated sevoflurane administered to volunteers using a 3% concentration for 8 h duration at approximately 2 L/min flow rate. ⋯ No significant excretion of protein, glucose or renal enzymes was observed. Application of these results to clinical practice must be interpreted in light of the experimental nature of the anesthetic administration. Although some controversy remains, these data, combined with results of recent studies in surgical patients, suggest that renal function following modest duration low-flow sevoflurane anesthesia is similar to that following isoflurane anesthesia.
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The new inhalational anesthetic sevoflurane is biotransformed by approximately 5%. Serum fluoride concentrations resulting from transformation mainly depend on rate of hepatic defluorination, total amount of anesthetic given and the solubility of the volatile anesthetic, as expressed by its blood gas partition coefficient. Enflurane is metabolized by 5-11%. ⋯ The threshold of fluoride nephrotoxicity of 50 mumol/l, which has been empirically found after methoxyflurane, and which is still listed in many medical textbooks, can not be assumed a marker of nephrotoxicity after isoflurane, enflurane or sevoflurane. Therefore also, the elevated serum fluoride concentrations, as regularly obtained after anesthesia with sevoflurane are devoid of clinical significance. In addition, exposure to sevoflurane or its metabolites is not associated with hepatic toxicity.