Der Anaesthesist
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The inhalational anaesthetic fluor-methyl-trifluor-1-(trifluoromethyl)-ethylether sevoflurane has been known for more than 20 years and is structurally related to the currently available volatile anaesthetics. This anaesthetic is characterized by a low blood/gas partition coefficient of 0.69 and high fat solubility, leading to a sharp rise in alveolar concentration and quick anaesthesia induction. As opposed to desflurane, sevoflurane does not boil at ambient temperature, thus making a special vaporizer unnecessary. ⋯ As opposed to methoxyflurane, which may be nephrotoxic due to its microsomal metabolism in kidney tissue, sevoflurane does not seem to cause clinical inhibition of renal function even at plasma fluoride levels above 50 mumol/l, a concentration thought to be associated with renal tubular impairment. A possible reason for this observation is lower metabolism of sevoflurane within renal tissues. Due to its quick onset and fast elimination, sevoflurane is an interesting new volatile anaesthetic offering various clinical advantages.
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The current increase in the cost of health care must be considered as a severe threat to the prehospital emergency services system. Two examples have been selected--the patient with polytrauma and the patient in cardiac arrest--to demonstrate the dilemma between a need for objective data and the requirements of emergency patients. Study results obtained in trauma patients indicating that total prehospital time, including scene time, is correlated to patient outcome have led to the conclusion that at the scene treatment by emergency physicians may be dispensable. ⋯ Politicians require an improvement in the quality of the validation of emergency measures, although the instruments available for the investigation of these measures are known to be obsolete (experimental models, experimental design). Additionally, the financial support of research in emergency medicine suffers from being accourded low priority by public research funds such as the German Research Fund. However, in view of the rapid application of experimental results to daily practice it should be emphasized that patients also support research in emergency medicine via their direct financial contributions to the health insurance companies.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Serum fluoride concentrations and exocrine kidney function with sevoflurane and enflurane. An open, randomized, comparative phase III study of patients with healthy kidneys].
Sevoflurane is a "new" volatile inhaled anaesthetic. Owing to its lower blood-gas solubility coefficient, emergence from anaesthesia is faster with sevoflurane than with isoflurane, enflurane, or halothane. Sevoflurane undergoes metabolic biodegradation, releasing inorganic fluoride ions that could produce nephrotoxicity. In this study, we compared serum inorganic fluoride concentrations (IFCs) in patients receiving either sevoflurane or enflurane. Furthermore, indices of renal function were evaluated until the 3rd postoperative day. ⋯ In our study 1.69 MAC-h sevoflurane produced peak serum IFCs of 34.5 mumol/l. This is in accordance with the investigation of Frink et al. [4], who reported approximately 30 mumol/l after 1.4 MAC-h sevoflurane. Peak serum IFCs with sevoflurane were twice those with enflurane. Within the first 24 h post-anaesthesia, fluoride levels decreased more rapidly after sevoflurane. AUC may be more important than peak serum IFC in evaluating patients who are at risk for renal concentrating defects. In our study there was no evidence of renal dysfunction in either group.