DOES CHOICE OF THE ANESTHETIC INFLUENCE RENAL-FUNCTION DURING INFRARENAL AORTIC-SURGERY

Reconstructive infrarenal aortic surgery is associated with impairment of renal function owing to vasoconstriction during and after aortic c ross-clamping. To assess the influence of anesthetic technique on rena l hemodynamics during aortic surgery, 34 patients received one of four anesthetics: isoflurane (n = 10), halothane (n = 9), droperidol (n = 8), and flunitrazepam (n = 7). Supplemental anesthesia consisted of mi dazolam, fentanyl, nitrous oxide in oxygen (50%), and pancuronium. Bef ore aortic cross-clamping, effective renal plasma flow (ERPF) (131iodo -hippuran clearance) and glomerular filtration rate (GFR) (technetium- 99-DTPA clearance) were low in the halothane and flunitrazepam groups (118.4 +/- 25. 6 and 170 +/- 35 mL/min for ERPF; 19.7 +/- 5.2 and 26.9 +/- 5.8 mL/min for GFR, respectively) and better preserved in the iso flurane group (253.4 +/- 51.5 and 44.9 +/- 8.4 mL/min, respectively; P < 0.05 between isoflurane and halothane groups) or in the droperidol group as regards GFR (75.4 +/- 9.4 mL/min, P < 0.05). During clamping, both renal variables were not markedly affected in any group except i n the droperidol group in whom GFR significantly decreased from precla mp value. The GFR was then significantly higher in the isoflurane grou p (49.5 +/- 9.2 mL/min) than in the halothane and flunitrazepam groups (14.8 +/- 3.7 and 26.5 +/- 10.1 mL/min, respectively; P < 0.05). Afte r aortic declamping, ERPF and GFR increased markedly in the halothane group, and there was no significant difference between the groups. The se results suggest that renal hemodynamics are less altered with drope ridol-fentanyl anesthesia during abdominal surgery but not during aort ic cross-clamping. With isoflurane, renal function was preserved durin g aortic cross-clamping for reconstructive infrarenal aortic surgery. On the other hand, halothane-fentanyl and flunitrazepam-fentanyl anest hesia were associated with severe but transient renal dysfunction duri ng abdominal surgery.