BJA Advance Access originally published online on December 23, 2005
British Journal of Anaesthesia 2006 96(2):207-212; doi:10.1093/bja/aei308
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
CRITICAL CARE |
Hypotensive epidural anaesthesia in patients with preoperative renal dysfunction undergoing total hip replacement
1 Department of Anesthesiology and 2 Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA
* Corresponding author. E-mail: sharrockn{at}hss.edu
Background. Hypotensive anaesthesia does not impair renal function after surgery in normal patients but there are no reports of hypotensive anaesthesia in patients with chronic renal dysfunction (CRD).
Methods. From a database of 1893 consecutive patients undergoing total hip replacement (THR) under hypotensive epidural anaesthesia (HEA) from 1999 to 2004, 54 patients were identified with CRD (preoperative serum creatinine 
124 µmol litre–1). Fifty matched pairs were identified for patients with normal renal function who have hypertension (n=50) or no hypertension (n=50). Changes in serum creatinine and blood urea nitrogen (BUN) were recorded daily for 3 days. Acute renal failure was defined as an increase in serum creatinine of 44 µmol litre–1.
Results. The mean duration of hypotension (MAP<55 mm Hg) was 94 min (range 35–305 min). The mean age was 71 yr. All patients with a creatinine level of 124 µmol litre–1 had a creatinine clearance of <40 ml min–1 1.73 m–2 (range: 13–56). Patients with CRD received more crystalloid during surgery (1755 ml) than the other two groups (1435 ml) (P<0.001). Otherwise, all three groups were similar. No patients developed evidence of acute renal dysfunction immediately after or by 24 h after surgery. Three patients with CRD had an increase in creatinine of >44 µmol litre–1 at 48 and 72 h after surgery in the setting of volume depletion (acute blood loss in two patients and early ileus in one). Renal function subsequently improved.
Conclusion. HEA, per se, when carefully managed does not appear to predispose patients with CRD to acute renal failure after THR.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  Y. L. Liu, J. Prowle, E. Licari, S. Uchino, and R. Bellomo Changes in blood pressure before the development of nosocomial acute kidney injury Nephrol. Dial. Transplant., February 1, 2009; 24(2): 504 - 511. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Lameire, W. van Biesen, E. Hoste, and R. Vanholder The prevention of acute kidney injury an in-depth narrative review: Part 2: Drugs in the prevention of acute kidney injury NDT Plus, February 1, 2009; 2(1): 1 - 10. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Craig and J. M. Hunter Recent developments in the perioperative management of adult patients with chronic kidney disease Br. J. Anaesth., September 1, 2008; 101(3): 296 - 310. [Abstract] [Full Text] [PDF]
|
|