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Serum Inorganic Fluoride Levels in Obese Patients during and after Enflurane Anesthesia

John B. Bentley, MD^*, Robert W. Vaughan, MD, Matthew S. Miller, BS, Jerry M. Calkins, MD, PhD^*, and A. Jay Gandolfi, PhD

Department of Anesthesiology, The University of Arizona, College of Medicine, Tucson, Arizona 85724.

Abstract

Serum ionic fluoride levels in 24 markedly obese patients (127.6 ± 6.0 kg) and seven nonobese control subjects (67.3 ± 1.2 kg) were compared during and following enflurane anesthesia (<2.0 MAC hr). Peak serum fluoride levels were higher (28.0 ± 1.9 vs 17.3 ± 1.3 µM/L, p < 0.01) and the rate at which fluoride levels increased was more rapid (slope 5.6 VS 2.5 µM/L/hr) in obese patients than in control patients. No clinical evidence of nephrotoxicity was found in either group. Vasopressin resistance tests were not performed, and thus it is unknown whether subclinical nephrotoxicity occurred in either study group. Possible reasons for increased enflurane metabolism in obesity are discussed. These possibilities include differences in fluoride ion kinetics, hepatic delivery and penetration of volatile anesthetics, and altered hepatic microsomal enzyme activity. Obesity rather than weight is an important determinant of anesthetic biotransformation.

Key Words: ANESTHETICS, Volatile: enflurane • IONS: fluoride • COMPLICATIONS: obesity • BIOTRANSFORMATION (DRUG): enflurane

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999