URINE PROTEIN SEPARATION BY GEOMETRICAL ELECTROPHORESIS AFTER ANAESTHESIA WITH SEVOFLURANE
Abstract:
Protein determination in urine above the normal values after low-flow anaesthesia with Sevoflurane has led us to study its nature and significance. Proteinuria after anaesthesia is caused by Sevoflurane degradation by carbon dioxide absorbers and the increased amount of fluorine ions in kidneys. Compound A resulting from Sevoflurane degradation by carbon dioxide absorbers causes renal toxicity in animals with tubular necrosis, clinically evidenced by proteinuria and glycosuria. Materials and method: We observed 62 patients in the Intensive Care Unit who were anesthetised with Sevoflurane for different surgical interventions on medium and long term. Thus, we analyzed 186 urine samples from the anesthetized patients by spectrophotometry at 600 nm and by electrophoresis. Urine samples were taken from patients, preoperatively and at 24 and 72 hours postoperatively and were analyzed without having been previously preserved in order to remove any possible errors. The patients who were accepted in the study had an anaesthetic risk ASA I-III, according to the classification of the American Society of Anaesthesiology, without a known renal pathology, with normal blood urea nitrogen and serum creatinine level in the preoperative period. The proteinuria was analyzed in a specialized laboratory of Mureş County Hospital with a Konelab 30i autoanalyzer by spectrophotometry at 600 nm. Protein electrophoresis was performed in the laboratory of the Department of Pathophysiology within the University of Medicine and Pharmacy of Târgu Mureş. Urinary protein levels were statistically analyzed, by applying the ANOVA test. The obtained data were statistically analyzed by calculating the “p” value which was considered statistically significant at a value less than 0,05. Results: A number of 61 patients were included in the study, with an average age of 59 years old, a mean BMI=23 and a sex ratio F/M=29/32 with an anaesthetic risk, ASA I/II/III=1/22/38, according to the classification of the American Society of Anaesthesiology. The anaesthetic characteristics were the following: an average duration of anaesthesia of 200 minutes (between 80 and 300 minutes) and a minimal alveolar concentration (MAC) of 1.8 (1.4 to 2.2). Discussion: This study is a prospective, observational one, in which we demonstrate the presence of proteinuria with statistical significance (p˂0.0001) after anaesthesia with Sevoflurane, data that we partially found in literature. Compund A, incriminated as triggering glomular toxicity after anaesthesia with Sevoflurane has to reach a level of 800 ppm (parts per million) in order to be toxic to the kidneys. The literature also mentions the appearance of albuminuria after Desfluran anaesthesia although the degradation of this anaesthetic agent by carbon dioxide absorbers does not produce the compound A.
full text article in Romanian (.RO) |
full text article in English (.EN) |