Comparison of the effects of inhalation anesthetics in the intraand postoperative periods during kidney transplantation

Background. Every year the number of patients with chronic renal failure is steadily increasing. Allogeneic kidney transplantation from a post-mortem donor is a radical method to cope with chronic renal failure, improving the quality and life expectancy of patients. Currently available inhalation anesthetics make it easy to control the depth of anesthesia; they are excreted by the lungs unchanged, providing a quick emergence from anesthesia and easy waking up of the patient. An “ideal” inhalation anesthetic used for kidney transplantation should have a minimal amount of adverse effects.

The aim was to compare the efficacy of inhaled anesthetics used for allogeneic kidney transplantation from a posthumous donor.

Material and methods. A randomized, prospective, single-center study included 62 patients with end-stage chronic renal failure. The subjects were divided into three groups depending on the type of the inhalation anesthetic used. The first group included patients who underwent low-flow inhalation anesthesia with desflurane, the second and third groups were comparator groups where patients received sevoflurane or isoflurane, respectively, as an inhalation anesthetic. When assessing hemodynamic parameters, most episodes of hemodynamic instability were seen in the isoflurane group; the most stable statistically significant values were observed in the sevoflurane group, and desflurane took an intermediate position.

Results. The use of desflurane as an inhalation anesthetic in a kidney transplant provided a quicker recovery of consciousness and early extubation of the patient after anesthesia compared to the sevoflurane or isoflurane use. So desflurane proved to be the most efficient of the three studied inhalation anesthetics.

Conclusion. Desflurane is the optimal inhalation anesthetic used in kidney transplantation.

1. Gautier SV, Khomyakov SM. Organ donation and transplantation in Russian Federation in 2017. 10th report of the National Registry. Russian Journal of Transplantology and Artificial Organs. 2018;20(2):6–28. (In Russ.). https://doi. org/10.15825/1995-1191-2018-2-6-28

2. Ryu K, Song K, Kim J, Kim E, Kim SH. Comparison of the analgesic properties of sevoflurane and desflurane using surgical pleth index at equi-minimum alveolar concentration. Int J Med Sci. 2017;14(10):994–1001. PMID: 28924371 https://doi.org/10.7150/ijms.20291

3. Khubutiya MS, Zhuravel SV, Lebedev ML, Romanov AA, Pinchuk AV, Storozhev RV. Comparison of combined general anesthesia with complex inhalation and epidural anesthesia for kidney and pancreas transplantation. Transplantologiya. The Russian Journal of Transplantation. 2014;(3):38–44. (In Russ.).

4. Yildirim M, Kucuk HF, Demir T, Yakupoglu S, Yavuz A, Ari E. Early allograft function in renal transplant recipients: is it affected by volatile anesthetics. Transplant Proc. 2015;47(5):1352–1355. PMID: 26093717 https://doi.org/10.1016/j. transproceed.2015.04.048

5. Park JH, Lee JH, Joo DJ, Song KJ, Kim YS, Koocorresponding BN. Effect of sevoflurane on grafted kidney function in renal transplantation. Korean J Anesthesiol. 2012;62(6):529–535. PMID: 22778888 https://doi.org/10.4097/ kjae.2012.62.6.529

6. Bonilla AJ, Pedraza P, Guativa M. Aspectos perioperatorios of the transplant. Rev Colom Anestesiol. 2007;35(1):67–74.

7. Magilevets VM. Anesteziya pri transplantatsii donorskoy pochki: metod. posobie. Tver': Triada Publ.; 2004. (In Russ.).

8. Sear JW. Anesthesia for patients undergoing renal transplantation. In: Morris P, Knechtle SJ. Kidney Transplantation. Principles and practice. 5th ed. Philadelphia, WB Saunders; 2001. p.184–207.

9. Gentz BA, Malan TP. Renal toxi city with sevoflurane: a storm in a teacup? Drugs. 2001;61(15):2155–2162. PMID: 11772127 https://doi.org/ 10.2165/00003495-200161150-00001

10. Gonsowski CT, Laster MJ, Ege EI, Ferrell LD, Kerschmann RL. Toxicity of compound A in rats. Effect of a 3-hour administration. Anesthesiology. 1994; 80(3):556–565. PMID: 8141452 https:// doi.org/10.1097/00000542-19940300000012

11. Khubutiya MSh, Zhuravel SV, Kozlov IA, Romanov AA, Goncharova II. Microdialysis - a new method of monitoring of the transplanted cadaveric kidneys function. Anesteziologiya i reanimatologiya. 2015;60(1):69–72. (In Russ.).

12. Khubutiya MSh, Zhuravel SV, Romanov AA, Goncharova II, Pinchuk AV. Early assessment of kidney allotransplantat function by microdialysis in perioperative period (Case report). Transplantologiya. The Russian Journal of Transplantation. 2014;(1):20–23. (In Russ.).

13. Campagna JA, Miller KW, Forman SA. Mechanisms of actions of inhaled anesthetics. N Engl J Med. 2003;348(21):2110–2124. PMID: 12761368 https://doi.org/10.1056/NEJMra021261

14. Wang C, Li L, Xu H, Lv H, Zhang H. Effect of desflurane-remifentanil or sevoflurane-remifentanil on early recovery in elderly patients: a meta-analysis of randomized controlled trials. Pharmazie. 2019;74(4):201–205. PMID: 30940302 https://doi.org/10.1691/ph.2019.8935

15. Ibrakhim RM, Averyanov DA, Schegolev AV, Makarenko EP. Does desflurane have advantages in comparison with sevoflurane at the planned intracranial interventions. Voenno-meditsinskiy zhurnal. 2016;337(7):11–17. (In Russ.).

16. Singh PM, Borle A, McGavin J, Trikha A, Sinha A. Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Under going Bariatric Surgery-a Meta-Analysis of Randomized Controlled Trials. Obes Surg. 2017;27(11):3031–3039. PMID: 28916989 https://doi.org/10.1007/s11695-0172929-6

17. Bellgardt M, Drees D, Vinnikov V, Procopiuc L, Meiser A, Bomberg H, et al. Use of the MIRUS™ system for general anaesthesia during surgery: a comparison of isoflurane, sevoflurane and desflurane. J Clin Monit Comput. 2018;32(4):623–627. PMID: 29633099 https://doi.org/10.1007/s10877-0180138-z

18. Tsukamoto M, Yamanaka H, Yokoyama T. Age-related differences in recovery from inhalational anesthesia: a retrospective study. Aging Clin Exp Res. 2018;30(12):1523–1527. PMID: 29500622 https://doi.org/10.1007/s40520-0180924-y

19. Yalcin S, Aydoğan H, Yuce HH, Kucuk A, Karahan MA, Vural M, et al. Effects of sevoflurane and desflurane on oxidative stress during general anesthesia for elective cesarean section. Wien Klin Wochenschr. 2013;125(1516):467–473. PMID: 23860695 https:// doi.org/10.1007/s00508-013-0397-0

20. Kazanci D, Unver S, Karadeniz U, Iyican D, Koruk S, Yilmaz MB, et al. A comparison of the effects of desflurane, sevoflurane and propofol on QT, QTc, and P dispersion on ECG. Ann Card Anaesth. 2009;12(2):107-112. PMID: 19602734 https://doi.org/10.4103/09719784.51361