Aprotinin does not impair renal haemodynamics and function after cardiac surgery.
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.
Schweizer
A
A
Division of Anaesthesiology, Hôpital Cantonal Universitaire, Geneve, Switzerland.
Höhn
L
L
Morel
D R
DR
Kalangos
A
A
Licker
M
M
D015121:6-Ketoprostaglandin F1 alpha / Q000378:metabolism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D007611:Aprotinin / Q000494:pharmacology*; D009320:Atrial Natriuretic Factor / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D006152:Cyclic GMP / Q000378:metabolism; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006490:Hemostatics / Q000494:pharmacology*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015842:Serine Proteinase Inhibitors / Q000494:pharmacology*; D013929:Thromboxane B2 / Q000378:metabolism
D006490:Hemostatics; D015842:Serine Proteinase Inhibitors; D013929:Thromboxane B2; D015121:6-Ketoprostaglandin F1 alpha; D009320:Atrial Natriuretic Factor; D007611:Aprotinin; D006152:Cyclic GMP