Effects of anesthetics on the kidney.

All general anesthetics employed clinically have significant and reversible effects on renal hemodynamics, water, and electrolyte excretion at concentrations in which they are usually employed for surgical anesthesia. Some of the mechanisms by which these effects are produced are discussed. The minmal depressant effect on renal function of epidural anesthesia is possibly related to local anesthetic effects on the central system and/or the kidney. Methoxyflurane has been demonstrated to produce renal dysfunction when administered in high concentrations for prolonged periods of time to obese patients. Metabolites of methosyflurane including fluoride and/or oxalate appear to be the cause of this problem. Problems of anesthetic management in patients with renal failure have been briefly summarized with specific attention to the undersirable effects of some neuromuscular blocking drugs.