Effects Of Norepinephrine On Renal Function In Patients During Kidney Transplantation Surgery

Objective: To investigate the feasibility of norepinephrine infusion at 0.01~0.4μg·kg-1·min-1during kidney transplantation surgery.Methods: 32 patients with ASA III~IV, aged 22~64yr, weight 44~88kg and no history of heart failure undergoing allograft renal transplantation were studied. Daily blood pressure was controlled relatively stable. Preoperation dialysis was performed within 36 hours. Combined spinal-epidural anesthesia (CSEA) was elected. Spinal anesthesia was performed at the L2~L3 interspace and hyperbaric 0.5% bupivacaine (10~15mg) was administered into the subrachnoid space. A sensory block to pinprick to T6. Epidural catheter was placed at the T11~T12 and 1% ropivacaine was given intermittently to maintain anesthesia. The patients were randomly allocated into 2 groups (n=16):D group intravenously received 1~10μg·kg-1·min-1 dopamine, while N group intravenously received 0.01~0.4μg·kg-1·min-1 norepinephrine when the blood pressure fell below day-to-day blood pressure before release of the graft vessel clamps. The patients were sedated with midazolam 1mg and continuous infusion of propofol at 2~4mg·kg-1·h-1 during surgery. ECG, IBP, CVP, HR and SPO2 were continuously monitored. SBP, DBP, MAP, CVP, HR and SPO2 were recorded before anesthesia (T0), before release of the graft vessel clamps (T1), 10min after release of the graft vessel clamps (T2) and at the end of surgery (T3). Peripheral vein blood and urine samples were obtained at the end of surgery (T3) and the twelfth postoperation hour (T4) for determination the concentration of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin. Urine volume was also recorded at the end of surgery (T3) and the twelfth postoperation hour (T4). Meanwhile , the frequency of furosemide used in twelve hours postoperation was memorized.Results: The two groups were comparable with respect to age, M/F sex radio, weight, operation time and volume of fluid infused. The hemodynamics was stable in each group and no adverse event was observed in any patient during surgery. At T3, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). At T4, the concentrations of serum Cystatin C,β2-microglobubin and urineα1-microglobubin,β2-microglobubin in both groups were no significance of difference (P>0.05). The urine volume at the end of surgery in group N compared with group D increased a lot, but there was no statistic meaning in both groups (P>0.05). The urine volume in postoperation 12h and the frequence of furosemide used in both groups were no statistic meaning (P>0.05). Conclusion: It's feasible that norepinephrine infusion intravenously at 0.01~0.4μg·kg-1·min-1 during kidney transplantation surgery. Because norepinephrine is proved equivalent to dopamine in every measured respect and it has no bad influence on graft function recovery.