Homocysteine Levels After Nitrous Oxide Anesthesia for Living-Related Donor Renal Transplantation: A Randomized, Controlled, Double-Blind Study

Homocysteine Levels After Nitrous Oxide Anesthesia for Living-Related Donor Renal Transplantation: A Randomized, Controlled, Double-Blind Study

Abstract Background Nitrous oxide anesthesia increases postoperative homocysteine concentrations. Renal transplantation candidates present with higher homocysteine levels than patients with no renal disease. We designed this study to investigate if homocysteine levels are higher in subjects receivin...

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Published in:Transplantation proceedings Vol. 47; no. 2; pp. 313 - 318
Main Authors: Coskunfirat, N, Hadimioglu, N, Ertug, Z, Akbas, H, Davran, F, Ozdemir, B, Aktas Samur, A, Arici, G
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-03-2015
Subjects:
Adult
Anesthesia, General
Anesthetics, Inhalation
Double-Blind Method
Female
Folic Acid - blood
Homocysteine - blood
Humans
Kidney Failure, Chronic - blood
Kidney Failure, Chronic - surgery
Kidney Transplantation
Living Donors
Longitudinal Studies
Male
Middle Aged
Nitrous Oxide
Postoperative Period
Prospective Studies
Surgery
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Summary:Abstract Background Nitrous oxide anesthesia increases postoperative homocysteine concentrations. Renal transplantation candidates present with higher homocysteine levels than patients with no renal disease. We designed this study to investigate if homocysteine levels are higher in subjects receiving nitrous oxide for renal transplantation compared with subjects undergoing nitrous oxide free anesthesia. Methods Data from 59 patients scheduled for living-related donor renal transplantation surgery were analyzed in this randomized, controlled, blinded, parallel-group, longitudinal trial. Patients were assigned to receive general anesthesia with (flowmeter was set at 2 L/min nitrous oxide and 1 L/min oxygen) or without nitrous oxide (2 L/min air and 1 L/min oxygen). We evaluated levels of total homocysteine and known determinants, including creatinine, folate, vitamin B12 , albumin, and lipids. We evaluated factor V and von Willebrand factor (vWF) to determine endothelial dysfunction and creatinine kinase myocardial band (CKMB)-mass, troponin T to show myocardial ischemia preoperatively in the holding area (T1), after discontinuation of anesthetic gases (T2), and 24 hours after induction (T3). Results Compared with baseline, homocysteine concentrations significantly decreased both in the nitrous oxide (22.3 ± 16.3 vs 11.8 ± 9.9; P  < .00001) and nitrous oxide-free groups (21.5 ± 15.3 vs 8.0 ± 5.7; P  < .0001) at postoperative hour 24. The nitrous oxide group had significantly higher mean plasma homocysteine concentrations than the nitrous oxide-free group ( P  = .021). The actual homocysteine difference between groups was 3.8 μmol/L. Conclusion This study shows that homocysteine levels markedly decrease within 24 hours after living-related donor kidney transplantation. Patients receiving nitrous oxide have a lesser reduction, but this finding is unlikely to have a clinical relevance.
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ISSN:0041-1345
1873-2623
DOI:10.1016/j.transproceed.2014.10.014