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Clinical Anesthesiology, 4e
| Section IV. Physiology, Pathophysiology, & Anesthetic Management > |
Effects of Anesthesia & Surgery on Renal Function
Sections: Effects of Anesthesia
& Surgery on Renal Function, Indirect Effects, Cardiovascular
Effects, Neural Effects, Endocrine Effects, Direct Anesthetic
Effects, Volatile Agents, Intravenous
Agents, Other Drugs, Direct Surgical
Effects.
Topics Discussed: anesthetics, intravenous; enflurane; halothane; isoflurane; kidney; laparoscopy; methoxyflurane; renal circulation; renal function; volatile anesthetics.
Excerpt:"Clinical studies attempting to define the effects of anesthetic
agents on renal function are complicated by difficulties in differentiating
between direct and indirect effects and often fail to control many
important variables. These variables include the type of surgical
procedure, fluid administration, and preexisting cardiac and renal
function. Several conclusions, however, can be stated:Most inhalation and intravenous anesthetics cause some degree
of cardiac depression or vasodilation and therefore are capable
of decreasing arterial blood pressure. The sympathetic blockade associated
with regional anesthesia (spinal or epidural) can similarly cause
hypotension as a result of increased venous capacitance and arterial
vasodilation. Decreases in blood pressure below the limits of autoregulation
can therefore be expected to reduce RBF, GFR, urinary flow, and
sodium excretion. Intravenous fluid administration often at least
partially reverses the hypotension and ameliorates its effects on
renal function.Halothane, enflurane, and isoflurane have been reported to decrease
renal vascular resistance. Studies of their effect on autoregulation
have had conflicting results. In some animal studies, halothane
appears to..."
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