What is the Role of Metabolism in Sevoflurane Toxicity?
Sevoflurane is minimally metabolized in the liver, where it undergoes oxidative defluorination by the cytochrome P450 enzyme system. This metabolic pathway releases inorganic fluoride ions and small amounts of Compound A. The generation of these metabolites, particularly fluoride ions, has been implicated in renal toxicity, although the clinical significance of this is still debated. Monitoring fluoride levels in patients undergoing prolonged anesthesia with sevoflurane can be considered to assess potential nephrotoxic effects.
