Browsing by Author "Sondekoppam, Rakesh V."

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    The future is now—it’s time to rethink the application of the Global Warming Potential to anesthesia
    (2019) Özelsel, Timur J.-P.; Sondekoppam, Rakesh V.; Buro, Karen
    All volatile anesthetic agents are fluorocarbons and variably potent greenhouse gases (GHG).1 As a chlorofluorocarbon (CFC), isoflurane also has ozone depleting potential (as does nitrous oxide [N2O]), while sevoflurane and desflurane, being hydrofluorocarbons (HFC), do not.1 The global emission of HFCs increased 128% from 1990 to 2005 and is projected by 2030 to increase a further 336% compared with 2005 emissions.2 The Montreal Protocol is an international treaty agreed upon in 1987 with the primary goal to protect the ozone layer and to reverse the ozone hole over Antarctica.1 While it is being heralded as a major multinational success, since it has led to the phase-out of CFCs3 and a subsequent slow recovery of the ozone layer, it has led to an increased use of HFCs, which are also very potent GHGs. The 2016 Kigali amendment to the Montreal Protocol further aims to phase-down those HFCs with a high potential for contributing to global warming.1 Unfortunately, the field of anesthesia finds itself in a unique position where the release of its CFCs and HFCs has actually increased over time.
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    The impact of sevoflurane anesthesia on postoperative renal function: a systematic review and meta-analysis of randomized-controlled trials
    (2020) Sondekoppam, Rakesh V.; Narsingani, Karim H.; Schimmel, Trent A.; McConnell, Brie M.; Buro, Karen; Özelsel, Timur J.-P.
    Purpose Renal damage secondary to fluoride ions and compound A (CpdA) after sevoflurane anesthesia remains unclear. For safety reasons, some countries still recommend minimum fresh-gas flows (FGFs) with sevoflurane. We review the evidence regarding the intraoperative use of sevoflurane for anesthesia maintenance and postoperative renal function compared with other anesthetic agents used for anesthetic maintenance. Secondarily, we examine the effects of peak plasma fluoride and CpdA levels and the effect of FGF and duration of anesthesia on these parameters. Source The databases of MEDLINE (OVID and Pubmed), EMBASE, the Cochrane Library, Health Technology Assessment Database, CINAHL, and Web of Science were searched from inception until 23 April 2020 to identify randomized-controlled trials (RCTs) in humans utilizing sevoflurane or an alternative anesthetic for anesthesia maintenance with subsequent measurements of renal function. Two different paired reviewers independently selected the studies and extracted data. The quality of the evidence was appraised using GRADE recommendations. Principal findings Of 3,766 publications screened, 41 RCTs in human patients were identified. There was no difference between creatinine at 24 hr (21 studies; n = 1,529), or creatinine clearance (CCR) at 24 hr (12 studies; n = 728) in the sevoflurane vs alternative anesthetic groups. Peak fluoride and fluoride measured at 24 hr were higher with sevoflurane compared with other inhaled anesthetics. Subgroup analyses for sevoflurane usage in various contexts showed no significant difference between sevoflurane and alternative anesthetics for creatinine or CCR at 24 hr at varying FGF, duration of exposure, baseline renal function, or absorbent use. Conclusions We did not find any association between the use of sevoflurane and postoperative renal impairment compared with other agents used for anesthesia maintenance. The scientific basis for recommending higher FGF with the use of sevoflurane needs to be revisited.