Aprotinin does not impair renal haemodynamics and function after cardiac surgery |
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Authors: | Schweizer A Höhn L Morel D R Kalangos A Licker M |
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Institution: | Division of Anaesthesiology, Hopital Cantonal Universitaire, Geneve, Switzerland. |
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Abstract: | Patients undergoing cardiac surgery with moderate hypothermic
cardiopulmonary bypass (CPB) were allocated randomly to receive either
saline (control group, n = 29) or a high-dose regimen of aprotinin
(aprotinin group, n = 28). In both groups, CPB was associated with similar
and transient increases in effective renal plasma flow (+54% in controls
and +48% in aprotinin-treated patients) and in fractional excretion of
sodium and potassium, but glomerular filtration rate remained unchanged.
Plasma and urinary ratios of 6-keto-PGF1 alpha to thromboxane B2 (TxB2)
increased significantly, indicating systemic and renal release of
vasodilatory prostaglandins. Osmolar clearance correlated with urinary
excretion of cyclic GMP (r = 0.79 and 0.86 in the control and aprotinin
groups, respectively) and 6-keto-PGF1 alpha (r = 0.63 and 0.69 in the
control and aprotinin groups, respectively). Compared with preoperative
values, plasma atrial natriuretic peptide increased after weaning from CPB
(+71% and +93% in the control and aprotinin groups, respectively).
Aprotinin had no apparent adverse effect on renal function and it did not
alter mechanisms involving prostanoids and atrial natriuretic peptide
during cardiac surgery.
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