Influence of the type of volatile anesthetic on the development of acute kidney injury after endovascular repair of aortic aneurysm: A randomised controlled trial (DESEVAR study)

Ana Arnalich-Montiel^1,2Irma M Barrio-Pérez¹Alba Burgos-Santamaría¹Carmen Fernandez.Riveira¹Alberto Lázaro²María Ángeles González-Nicolás²Javier Río³Jose María Bellón⁴María Iluminada Canal¹Jose Manuel Ligero³Begoña Quintana-Villamandos^1,2*

• ¹Department of Anesthesiology and Resuscitation, Gregorio Marañón Hospital, Madrid, Spain
• ²Universidad Complutense de Madrid, Madrid, Spain
• ³Hospital General Universitario Gregorio Maranon, Madrid, Spain
• ⁴Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid, Spain

Abstract Acute kidney injury (AKI) frequently occurs after endovascular aortic aneurysm repair (EVAR) leading to significant morbidity and mortality. It is associated with contrast administration, hypovolemia, arterial microembolization due to renal artery manipulation, ischemia reperfusion syndrome, as well as other patient comorbidities. However, little is known about the effect of volatile anesthetics on the development of AKI in this context. Therefore, we aimed to investigate renal function in patients anesthetised with desflurane or sevoflurane for EVAR. For this, we conducted a single-center randomized clinical trial involving 80 patients scheduled for elective EVAR under general anesthesia. Patients were randomly assigned to desflurane or sevoflurane anesthesia group. Biochemical variables of kidney function and biomarkers for AKI were studied at 3 different moments: before surgery, after surgery and 24h after surgery. Plasma creatinine, cystatin C, estimated glomerular filtration, uric acid, and kidney injury molecule-1 did not significantly change between both groups. Mixed linear model shows a significant interaction (p = 0.01) of plasma neutrophil gelatinase-associated lipocalin (NGAL) between sevoflurane vs. desflurane. Both groups showed a progressive increase in plasma NGAL (sevoflurane 3.713 ng/ml, p < 0.001 and desflurane 1.774 ng/ml, p < 0.001) when comparing the moment before surgery with respect to 24h after surgery. However, sevoflurane caused a higher plasma NGAL concentration than desflurane after 24h of surgery (8.66 ± 5.09 ng/ml vs. 6.51 ± 3.86 ng/ml, P = 0.03). Desflurane was associated with a lower postoperative AKI compared with sevoflurane in patients undergoing EVAR. Further research is required to corroborate our results and evaluate clinical importance. Trial registration: EudraCT: 2016-003906-16; ClinicalTrials.gov: NCT03917186.