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Scritto da Critical Care
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 IntroductionThe renal clearance of infused crystalloid fluid is very low during anaesthesia and surgery, but experiments in conscious sheep indicate that the renal fluid clearance might approach a normal rate when the adrenergic balance is modified.Methods:60 females (mean age, 32 years) undergoing laparoscopic gynecological surgery were randomized to control group and received only the conventional anesthetic drugs and 20 ml/kg of lactated Ringer's over 30 mins. The others were also given an infusion of 50 ug/kg/min of esmolol (beta1-receptor blocker) or 0.01 ug/kg/min of phenylephrine (alpha1-adrenergic agonist) over 3 hours. The distribution and elimination of infused fluid was studied by volume kinetic analysis based on urinary excretion and blood hemoglobin level.Results:Both drugs significantly increased urinary excretion while heart rate and arterial pressure remained largely unaffected. The urine flow during non-surgery was 43, 147, and 176 ml in the control, esmolol, and phenylephrine groups, respectively (medians, P<0.03). When surgery had started the corresponding values were 34, 65 and 61 ml (P<0.04). At 3 hours, an average of 9%, 20%, and 25% of the infused volume had been excreted in the three groups (P<0.01). The kinetic analyses indicated that both treatments slowed down the distribution of fluid from the plasma to the interstitial fluid space, thereby preventing hypovolemia.Conclusions:Esmolol doubled and phenylephrine almost tripled urinary excretion during anesthesia-induced depression of renal fluid clearance.
Fonte: Critical Care |
