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British Journal of Anaesthesia, 2003, Vol. 91, No. 6 800-804
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Fluoride metabolism in smokers and non-smokers following enflurane anaesthesia

M. Laisalmi*,1, A. Soikkeli1, H. Kokki2, H. Markkanen3, A. Yli-Hankala4, P. Rosenberg1 and L. Lindgren4

1 Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. 2 Department of Anaesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland. 3 Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland. 4 Department of Anaesthesia and Intensive Care Medicine, Tampere University Hospital, Tampere, Finland

*Corresponding author: Department of Anaesthesiology and Intensive Care, PO Box 1777, FIN-70211 Kuopio, Finland. E-mail: merja.laisalmi@kuh.fi

Background. Inorganic fluoride is released by the metabolism of enflurane and the increased serum fluoride concentrations may impair renal function. Tobacco smoke consists of numerous reactive compounds that can either induce or inhibit drug metabolism. Studies on the interaction of smoking with anaesthetic drug metabolism and possible toxicity are warranted.

Methods. Sixteen non-smoking and 17 smoking (>10 cigarettes day–1) generally healthy women undergoing elective gynaecological surgery were given 1 MAC (minimum alveolar concentration)-hour standardized anaesthesia with enflurane in oxygen–air mixture. The serum inorganic fluoride and renal function markers ß2-microglobulin, tumour-associated trypsin inhibitor (TATI) and serum creatinine were measured for 48 h.

Results. The greatest inorganic fluoride concentration was between 8.4 and 21.0 (mean 13.8 (SD 3.4)) µmol litre–1 in the non-smokers and between 8.6 and 38.0 (18.7 (7.0)) µmol litre–1 in the smokers; the mean difference was 4.9 µmol litre–1 (95% confidence interval (CI) 1.0–8.8, P<0.05). Serum ß2-microglobulin, TATI and creatinine were not increased. Serum inorganic fluoride concentrations were significantly greater in the smokers compared with the non- smokers 1, 2, 3 and 6 h after 1 MAC-hour inhalation with enflurane (P<0.05). Inorganic fluoride concentrations were still increased 24 h after anaesthesia in both groups. Urine ß2-microglobulin and TATI creatinine ratio remained at low values during the whole 48-h period in both groups.

Conclusions. Regular smoking is associated with an increase in serum inorganic fluoride concentration after anaesthesia with enflurane, but there are no signs of renal damage.

Br J Anaesth 2003; 91: 800–4


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