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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 1999 December;65(12):867-77

language: English

Prevention of acute renal failure in major vascular surgery

Bertolissi M.

Second Department of Anesthesia and ICU, Azienda Ospedaliera S. Maria della Misericordia - Udine


The aim of ­this ­study was to ana­lyse the ­main prob­lems ­which ­involve ­renal func­tion in ­major vas­cular sur­gery and can ­lead to post­op­er­a­tive ­acute ­renal ­failure. The fac­tors respon­sible for ­renal ­damage in ­this sur­gical ­branch are at ­first ana­lysed, ­then fol­lowed by the phys­io­log­ical ­changes ­which char­ac­terize the ­renal ­injury, the tech­niques ­employed to ­detect and mon­itor ­them and ­finally the ther­a­peutic ­tools avail­able to pre­vent ­acute ­renal ­failure. The ­most sig­nif­i­cant ­data of per­sonal expe­ri­ence on the use of nifed­i­pine and low-­dose dop­a­mine ­during abdom­inal ­aortic sur­gery are ­then pre­sented. It is con­cluded ­that: a) an ­ischemic ­attack is the ­main ­cause of ­acute ­renal ­failure in ­mayor vas­cular sur­gery; b) pre­ven­tion of ­ischemic ­renal ­damage is far ­superior to treat­ment; c) the ­optimal man­age­ment of the car­dio­vas­cular func­tion by ­means of the inva­sive hemo­dy­namic mon­i­toring, is the ­main ­tool to pro­tect the kid­neys and pre­vent ­acute ­renal ­failure; d) the phar­mac­o­log­ical pro­tec­tion by diu­retics and low-­dose dop­a­mine is of ­minor impor­tance and ­anyway sub­or­di­nate to the main­te­nance of ade­quate hemo­dy­namics, as ­well as for cal­cium antag­o­nist ­whose employ­ment how­ever ­seems to pro­tect the kid­neys ­better ­against an ­ischemic ­attack.

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