1 Christian-Albrechts-University Kiel, Brunswiker Strasse 10, D-24105 Kiel, Germany. 2 University-Hospital Hamburg Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany
Corresponding author: Klinik und Poliklinik für Anästhesiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. E-mail: tkrause@uke.uni-hamburg.de
Accepted for publication: September 17, 2002
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Abstract |
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Methods. Anaesthesia was induced by inhalation of up to 8% sevoflurane and maintained at 2.53% in oxygen/nitrous oxide (65/35%) at a fresh gas flow of 3 litre min1. Soda lime (humidity 1215%) was used as a carbon dioxide absorbent. Blood was drawn directly before induction and after termination of anaesthesia. Twenty-five second division metaphases of mitogen-stimulated T-lymphocytes per blood sample were screened for SCE rates using standard techniques.
Results. Average duration of anaesthesia was 49.6 (SD 24.0) min. Before anaesthesia induction, 7.93 (1.23) SCE per metaphase were determined. After sevoflurane anaesthesia [1.40 (0.77) MAC h] 7.92 (1.19) SCE per metaphase were observed. Additionally, no differences were evident between male or female children.
Conclusion. Short-term administration of sevoflurane anaesthesia did not induce SCE in T-lymphocytes of children. No indication for a possible genotoxic effect has been observed.
Br J Anaesth 2003; 90: 2335
Keywords: anaesthetics volatile, sevoflurane; metabolism, sevoflurane; toxicity, genotoxicity
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Introduction |
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Methods and results |
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Comment |
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Our results indicate that short-term sevoflurane anaesthesia does not induce SCE ex vivo in children, even when administered at high doses of up to 8% at a fresh gas flow rate of 3 litre min1. Compound A concentrations in the anaesthesia circuit using a fresh gas flow rate of 2 litre min1 have been estimated to reach a maximum of 32 p.p.m.5 Sevoflurane concentration, ventilation, fresh gas flow rate and type, temperature and humidity of the carbon dioxide absorbent influence the formation of Compound A. Highest concentrations occur when fresh gas flow is low, and current USA Food and Drug Administration recommendations state that flow rates <2 litre min1 are not recommended in a circle absorber system.6
To date, no available clinical data indicate that sevoflurane might be genotoxic in man. Our results support the safety of sevoflurane administration as no evidence for a possible genotoxic potential of sevoflurane in paediatric anaesthesia was observed. Nevertheless, it cannot be excluded that, under certain conditions during sevoflurane anaesthesia (e.g. with dry soda lime or at a low fresh gas flow rate), Compound A and further degradation products might be generated at a remarkable and possible genotoxic rate. It has been postulated that, chronic exposure to waste anaesthetic gases might cause genotoxicity in operating room personnel,7 but the results in humans are still conflicting.8 From the International Agency for Research on Cancer, volatile anaesthetics have been placed into the category of non-classifiable agents with respect to carcinogenicity in humans.9 Further investigations should clarify possible effects of long-term sevoflurane anaesthesia and chronic exposure to waste sevoflurane gases on the formation of SCE. Chemically inert carbon dioxide absorbents such as Amsorb®10 might be helpful to avoid degradation of sevoflurane to Compound A.
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References |
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