Nifedipine Can Preserve Renal Function in Patients Undergoing Aortic Surgery with Infrarenal Crossclamping

Abstract

Sixteen patients diagnosed with an aneurysm of abdominal aorta or Leriche disease underwent elective aortic surgery involving crossclamping of infrarenal aorta (ICC). These patients were randomized into two equal groups and 8 patients were infused with nifedipine starting from the isolation of aorta until the end of surgery (group A) while another 8 patients were infused with low-dose dopamine (group B) over the same surgical course. Plasma endothelin (ET) was measured before the induction of anesthesia, at the beginning and at the end of the clamp period and at the end of the operation. Intraoperatively, creatinine clearance and urinary excretion of PGE₂, 6-keto PGF_1α and TxB₂ were also determined before, during and after aortic crossclamping. Pre-operative GFR as well as preinduction cardiac index (CI) and pulmonary capillary wedge pressure (PCWP) of the two groups did not differ. During crossclamping plasma ET rose significantly in both groups. However, after clamp removal, plasma ET decreased in group A while it remained elevated in group B. Urinary excretion of TxB₂, PGE₂ and 6-keto PGF_1α increased during clamp in both groups, but the ratio of PGE2 + 6-keto PGF_1α/TxB₂ during and after clamp was significantly higher in group A than in B. Postclamp creatinine clearance decreased in group B, and increased in group A; postoperative value of GFR was unchanged in group A and decreased significantly in group B. In conclusion, infusion of nifedipine, in contrast to dopamine, prevented the decrease of GFR in patients undergoing aortic surgery. This effect could be mediated by a nifedipine modulation of ET vascular synthesis and/or a preferential renal synthesis of vasodilating prostanoids.

Systematic review: The use of diuretics and dopamine in acute renal failure: a systematic review of the evidence

“…Seven diuretics studies were located via MEDLINE and another three from review article bibliographies [3,4,5,6,7,8,9,10,11,12]. For dopamine these numbers were 13 and 17, respectively [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42]. The results of the critical appraisal are shown in Tables 3–4.…”

“…The results of a small level V study by Palmieri et al [26] appear to suggest that dopamine may be useful in shortening the recovery time from interleukin-2-induced ARF. Apart from these two studies, the remaining 17 [13,14,15,16,17,18,19,20,21,22,23,24,25,27,29,30,31,32,33,34,35,36,37,39,40,41,42], collectively enrolling over 700 patients, are all negative. Among these is a recent level II study by Lherm et al [14] in which dopamine infusion failed to improve renal function in patients with sepsis except for transiently increasing creatinine clearance in patients without shock.…”

Atrial natriuretic peptide infusion improves ischemic renal failure after suprarenal abdominal aortic cross-clamping in dogs

“…Because of severe ischemia-reperfusion injury in this model, a potent vasoconstrictor, such as endothelin, might decrease renal blood flow. In patients undergoing aortic surgery, plasma endothelin concentrations rose during aortic cross-clamping that was related to the postoperative decrease in glomerular filtration rate (26). ANP has also been shown to reverse the endothelininduced vasoconstriction (27).…”

Prevention of renal ischemia/reperfusion injury in rats using acetylcysteine after anesthesia with isoflurane

“…Nitescu et al 8 The animals in the present experiment were anesthetized with isoflurane, an anesthetic that has major influence on organ injuries through pre-and post-conditioning. The mechanism known as ischemic preconditioning (IPC) is an endogenous and fundamental protection against tissue injury 22 , observed in many animal species.…”