Abstract
Fifty four patients undergoing infrarenal abdominal aneurysmectomy were studied to observe perioperative renal function in association with hemodynamic and endocrine function and also to see the implication of anesthetic technics.
They were dev i ded into 4 groups: NLA (fentanyl 10mcg/kg, N=13), MDF (moderate dose fentanyl: 30mcg/kg, N=15), GOF (halothane 0, 5-1, 0%, N=12) and BTP group (butorphanol 75mcg/kg, N=14). Measurements of renal function, hemodynamics and plasma catecholamine (HPLC), renin activity, aldosterone and vasopressin levels (RIA) were serially repeated from preanesthesia through postoper-ative day 2.
Renal function was well maintained above preanesthesia level in all groups except in BTP group, throughout the entire study periods. GOF group showed the highest values in renal parameters, while GFR was slightly reduced following aortic cross-clamping in BTP group. Cardiac output decreased during aortic clamping without any difference between groups. Atrial pressures significantly increased during surgery, but these elevations were less in BTP group, which might reflect a relative hypovolemia. Intraoperative hypotension was less in GOF group. Although plasma catecholamine and vasopressin levels increased during surgery, these increases were the most pronounced in BTP group and the least in MDF group. However, renin-aldosterone system was highly activated in GOF group.
These results suggest that optimal fluid loading and blood replacement and avoidance of hypotension, in association with adequate anesthesia level to attenuate endocrine response may be required to prevent perioperative renal insufficiency in abdominal aneurysmectomy.