간절제술 중 nitroglycerin을 이용한 저중심정맥압 유지기법 시 저용량 dopamine 투여에 의한 신기능 변화

Abstract

Background: The maintenance of low central venous pressure (LCVP) induced by fluid restriction and nitroglycerin administration reduces the overall blood loss during major hepatic resections. We studied the postoperative renal function in hepatectomized patients under LCVP maintenance with nitroglycerin. In addition, the renal effect of low dose dopamine combined with nitroglycerin was evaluated. Methods: A total of 60 patients were randomly divided into two groups: a nitroglycerin group (n = 30), and a nitroglycerin and dopamine group (n = 30). During the Pringle maneuver the central venous pressure (CVP) was maintained at ＜ 5 mmHg in both groups. The nitroglycerin group received 0.5-1μg/kg/min nitroglycerin before and during the Pringle maneuver, but in nitroglycerin and dopamine group, 3μg/kg/min dopamine was administered with nitroglycerin. Mean arterial pressure, CVP, and urine output were measured before, during, and after the Pringle maneuver. BUN and serum creatinine were measured on postoperative days 1 and 3. Results: No significant differences were observed between the mean arterial pressures, CVPs, or urine outputs of the two groups. In both groups, urine output reduced after the Pringle maneuver but increased more in the nitroglycerin and dopamine group than in the nitroglycerin control group after anesthesia. There was no overall statistical change in either BUN or creatinine in either group. Conclusions: We conclude that LCVP induced by nitroglycerin with the Pringle maneuver during hepatectomy does not cause postoperative renal dysfunction, and that the use of low dose dopamine with nitroglycerin has no meaning in terms of preventing renal dysfunction in this situation. (Korean J Anesthesiol 2004; 47: 796∼802)