PROSPECTIVE-STUDY OF POSTOPERATIVE RENAL-FUNCTION IN OBSTRUCTIVE-JAUNDICE AND THE EFFECT OF PERIOPERATIVE DOPAMINE

A prospective study was undertaken to assess postoperative renal dysfu nction in patients with obstructive jaundice and to determine the effe ctiveness of dopamine in reducing its incidence. A total of 23 patient s undergoing surgical relief of obstructive jaundice (serum bilirubin level above 100 mu moll(-1)) were randomized into two groups. Those in the control group (n=10) received 3 litres 5 per cent dextrose intrav enously during the 24 h before surgery plus a bolus of intravenous fru semide 1 mg kg(-1) at induction of anaesthesia. The second group (n=13 ) received a similar fluid and frusemide regimen plus an infusion of d opamine 3 mu g kg(-1) min(-1) starting at induction of anaesthesia and continuing for 48 h after surgery. Postoperative oliguria occurred in two of the ten patients in the control group and in three of the 13 g iven dopamine (P=0.74). No patient developed acute renal failure. Ther e was no significant difference in mean levels of serum bilirubin, ure a and creatinine, creatinine clearance and 24-h urinary output, on the day before and on days 1-5 after operation, between the two groups. I t is concluded that, with careful preoperative resuscitation and contr ol of fluid and electrolyte balance, the incidence of postoperative re nal dysfunction in patients with obstructive jaundice is not as high a s in some previous studies and is unaltered by administration of perio perative low-dose dopamine.