Effects of hypertonic mannitol on renal function in open heart surgery.

Nishimura, Osamu; Tokutsu, S; Sakurai, Takeo; Takimoto, M; Ohta, Hisao; Yamaoka, Yoshiyuki; Okada, Kazuo; Suzuki, Yoshio; Yokoi, Hideki; Enomoto, Koichiro; Okada, Naniwa

doi:10.1536/ihj.24.245

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…Mannitol is an osmotic diuretic that is often added to the priming circuit during CPB. Although some studies have demonstrated that mannitol increases urine output in cardiac surgery patients, 132,133,140,141 it has not been shown to improve kidney function. 134,142 Furthermore, there is evidence that mannitol is associated with increased risk of renal tubular injury, particularly when administered with dopamine.…”

Section: Postoperative Managementmentioning

confidence: 99%

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Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care

Lau

Wald

Sladen

et al. 2015

Semin Cardiothorac Vasc Anesth

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Acute kidney injury (AKI) is a serious postoperative complication following cardiac surgery. Despite the incidence of AKI requiring temporary renal replacement therapy being low, it is nonetheless associated with high morbidity and mortality. Therefore, preventing AKI associated with cardiac surgery can dramatically improve outcomes in these patients. The pathogenesis of AKI is multifactorial and many attempts to prevent or treat renal injury have been met with limited success. In this article, we will discuss the incidence and risk factors for cardiac surgery associated AKI, including the pathophysiology, potential biomarkers of injury, and treatment modalities.

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Section: Postoperative Managementmentioning

confidence: 99%

“…In initial animal and experimental models, furosemide and other loop diuretics increased oxygen levels in the renal medulla. 126,132,133 Further studies also demonstrated protection of renal tubular damage after ischemic reperfusion and nephrotoxic injury. 127,128,134…”

Section: Postoperative Managementmentioning

confidence: 99%

Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care

Lau

Wald

Sladen

et al. 2015

Semin Cardiothorac Vasc Anesth

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show abstract

“…Mannitol: Mannitol is an osmotic diuretic that is very commonly administered during cardiac surgery as part of the CPB circuit prime. Although several studies of cardiac surgical patients have confirmed increased urine output during the period following mannitol administration, 84,85 very few have carefully assessed postoperative renal dysfunction in these patients. Ip-Yam and colleagues found no benefit of mannitol during CPB in a study of 23 patients.…”

Section: Diuretic Agentsmentioning

confidence: 99%

Evidence-Based Renal Protection in Cardiac Surgery

Stafford‐Smith

2005

Semin Cardiothorac Vasc Anesth

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Acute renal dysfunction is a common serious complication of cardiac surgery. Although a diversity of mechanisms exist by which the kidney can be damaged during cardiac surgery, atheroembolism, ischemia-reperfusion, and inflammation are believed to be primary contributors to perioperative renal insult. In addition, the high metabolic demands of active tubular reabsorption and the oxygen diffusion shunt characteristic of renal circulation make the kidney particularly vulnerable to ischemic injury. Remote effects of acute renal injury likely contribute to the strong association of this condition with other major postoperative morbidities and mortality and justify the search for renoprotective agents, even when dialysis is never required. Nonpharmacologic preventive strategies include procedure planning that is based on risk stratification, avoidance of nephrotoxins, and meticulous perioperative clinical care, including optimizing intravascular volume and attention to modifiable risk factors such as minimizing hemodilution. Although numerous pharmacologic interventions to prevent or treat acute renal injury have shown promise in animal models, randomized placebo-controlled clinical trials that have looked at measures of significant adverse outcomes such as death and dialysis have not confirmed a benefit.

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“…49511 Hyperosmolar agents such as mannitol, increase the osmolarity of the extracellular fluid slowing the intracellular influx of water, which counteracts the effect of Na+accumulation within the cell. 51 This hypertonicity has been shown to prevent the formation of intracellular edema during ischemia. Mannitol may also play a role in preventing the damaging effects of free hydroxyl radicals produced during reoxygenation.…”

Section: Protection During Cardiopulmonary Bypass ___________________...mentioning

confidence: 99%

The Neonatal Heart: Developmental Differences, Response to Ischemia, and Protection during Cardiopulmonary Bypass

Stammers,

Bove

1986

J Extra Corpor Technol

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(J. Extra-Corpor. Tech. 18[4] p. 208–218 Winter 1986) Accompanying the advent of open heart surgery was the need to better understand the relationship between ischemic damage and cell viability. Corrective cardiac surgical procedures necessitate a flacid, bloodless field to provide the surgeon optimal exposure. This interruption of blood flow, however, has many deleterious effects. A non-homogeneous cascade of events is produced that, if allowed to proceed unchecked, will ultimately lead to cell death. The time period of interrupted flow to the myocardium is referred to as ischemia, and results in certain cellular perturbations that are dependent on both temporal and temperature related factors. The effects of ischemia have been studied extensively, both clinically and in the laboratory, utilizing various techniques that almost exclusively employ the adult myocardium as a model. The resultant information has been broadly applied in formulating methods of myocardial protection across all ages. Cardiovascular physiology, however, is directly dependent upon the developmental state of the myocyte, showing changes in mechanical function, structure, and response to pharmacologic intervention throughout ontogeny. Therefore, a better understanding of the inherent differential characteristics must be considered in optimizing a plan for the ideal method of myocardial preservation in newborn hearts. This review will attempt to highlight some of the major developmental differences in the neonate, the effects of ischemia on the immature heart, and methods of myocardial protection during cardiopulmonary bypass.

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Effects of hypertonic mannitol on renal function in open heart surgery.

Cited by 6 publications

References 14 publications

Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care

Acute Kidney Injury in Cardiac Surgery and Cardiac Intensive Care

Evidence-Based Renal Protection in Cardiac Surgery

The Neonatal Heart: Developmental Differences, Response to Ischemia, and Protection during Cardiopulmonary Bypass

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