Renal Effects of the Inhalation Agents

Published on 07/02/2015 by admin

Filed under Anesthesiology

Last modified 07/02/2015

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Renal Effects of the Inhalation Agents

Richard L. Applegate, II, MD

Inhalation anesthetic agents can alter renal function through physiologic effects or through toxic effects of the agents or their breakdown products. Physiologic effects of inhalation anesthetics are typically transient. The risk for renal toxicity with modern inhalation agents is low.

Physiologic Effects

Autoregulation of renal blood flow appears to be maintained during administration of modern inhalation anesthetic agents, though the use of these agents associated with changes in cardiovascular function that may include decreases in cardiac output and arterial pressure. If prolonged, these decreases may adversely affect renal function. However, perioperative renal dysfunction is most commonly caused by intravascular volume depletion and anemia, leading to hypoperfusion of the kidney, with intracellular hypoxia. The impact of surgical stress may add to renal ischemia, as the kidney has few β2-adrenergic receptors; therefore, catecholamine stimulation leads to unopposed renal vasoconstriction. Additionally, positive-pressure ventilation during anesthesia is associated with reversible decreases in renal perfusion pressure, creatinine clearance, and sodium excretion, as is abdominal insufflation during laparoscopic procedures.

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