Nephrotoxic effect of methoxyflurane anesthesia. A case report.

A patient with normal preoperative hepatic and renal laboratory findings was exposed to relatively low concentrations of methoxyflurane during a routine anaesthetic procedure. For at least 12 postoperative days, the patient showed unusually high level of inorganic serum fluoride; his urinary excretion of fluoride and oxalic acid were also increased. However, he had no clinical signs of nephrotoxicity. This observation suggests that some patients with presumably normal renal function may have a low threshhold for the nephrotoxic effects of methoxyflurane.     

Heart disease indicators in patients with aortocoronary bypass operation.

The incidence of cardiovascular disease risk factors and other indicators of cardiac impairment were studied in 478 patients prior to their aortocoronary vein bypass operation and 194 patients who had angiographic examination but did not undergo the operation because the clinical and coronary angiographic findings were not considered serious enough to warrant the bypass procedure. The patients referred for surgery had higher plasma cholesterol and triglyceride levels (259 and 219 vs 233 and 180 mg/100 ml), tended to be older (53 vs 49 years) and had more extensive occlusive disease (occlusion score 200 vs 70) than the group without the operation. There was little difference in the proportion of smokers (81 vs 83%) or prevalence of hypertension (33 vs 30%). In comparison with 9,964 participants of a local health screening program, both patient groups had markedly higher prevalence of smoking, hypertension, chest pain and previous myocardial infarcts.     

Coronary artery occlusion and blood lipids

A possible correlation between the levels of plasma cholesterol and triglycerides and the extent of coronary artery occlusion as determined by angiography was studied in 481 male patients. In older patients (over 58 years of age), a pronounced coronary occlusion was frequently found at plasma cholesterol levels which could be considered normal for that age; while in the younger group (less than 48 years of age), extensive occlusive disease was mainly seen in the presence of elevated plasma cholesterol levels. The correlation between plasma triglyceride levels and coronary occlusion seemed to be less pronounced than was the case with plasma cholesterol levels. However, in patients with low cholesterol levels, an increase of plasma triglycerides was associated with more severe occlusive disease.