Extrahepatic metabolism of sevoflurane in children undergoing orthotopic liver transplantation.
Van Obbergh LJ, Verbeeck RK, Michel I, Lim S, Veyckemans F
Department of Anesthesiology and School of Pharmacy, Universite Catholique de Louvain, Brussels, Belgium. vanobbergh@anes.ucl.ac.be
BACKGROUND: Sevoflurane is metabolized by cytochrome P450 and produces
inorganic fluoride. The anhepatic phase of liver transplantation provides
a useful tool to study the extrahepatic metabolism of drugs. The authors
therefore studied the extrahepatic metabolism of sevoflurane by measuring
the fluoride production in children receiving sevoflurane solely during
the anhepatic phase of orthotopic liver transplantation. METHODS: Children
with end-stage liver disease undergoing orthotopic liver transplantation
were studied. Anesthesia was provided with isoflurane, sufentanil, and
pancuronium. In one group, isoflurane was replaced by sevoflurane as soon
as the liver was removed from the patient and maintained until reperfusion
of the new liver. Arterial blood samples were drawn at induction, before
removal of the liver, 15 min and 30 min after the beginning of the anhepatic
phase, at the unclamping of the new liver, and finally 60 and 120 min after
the unclamping. Plasma fluoride concentrations were determined by ion-selective
electrode. RESULTS: No differences between the two groups (n = 10) regarding
age, weight, duration of the anhepatic phase, or basal level of inorganic
fluoride were found. The fluoride concentration increased significantly
as soon as sevoflurane was introduced; it remained stable in the group
receiving isoflurane. The peak fluoride concentration was also significantly
higher in the first group (mean +/- SD: 5.5 +/- 0.8 microM (sevoflurane
group) versus 1.4 +/- 0.5 microM (isoflurane group) P < 0.05).
CONCLUSIONS: These results demonstrate the existence of an extrahepatic metabolism of sevoflurane at least in children with end-stage liver disease.
Publication Types:
Clinical trial
PMID: 10719946, UI: 20182865