title: Hypotensive epidural anaesthesia in patients with preoperative renal dysfunction undergoing total hip replacement.
abstract: BACKGROUND
  Hypotensive anaesthesia does not impair renal function after surgery in normal patients but there are no reports of hypotensive anaesthesia in patients with chronic renal dysfunction (CRD).
  
  
  METHODS
  From a database of 1893 consecutive patients undergoing total hip replacement (THR) under hypotensive epidural anaesthesia (HEA) from 1999 to 2004, 54 patients were identified with CRD (preoperative serum creatinine > or =124 micromol litre(-1)). Fifty matched pairs were identified for patients with normal renal function who have hypertension (n=50) or no hypertension (n=50). Changes in serum creatinine and blood urea nitrogen (BUN) were recorded daily for 3 days. Acute renal failure was defined as an increase in serum creatinine of 44 micromol litre(-1).
  
  
  RESULTS
  The mean duration of hypotension (MAP<55 mm Hg) was 94 min (range 35-305 min). The mean age was 71 yr. All patients with a creatinine level of 124 micromol litre(-1) had a creatinine clearance of <40 ml min(-1) 1.73 m(-2) (range: 13-56). Patients with CRD received more crystalloid during surgery (1755 ml) than the other two groups (1435 ml) (P<0.001). Otherwise, all three groups were similar. No patients developed evidence of acute renal dysfunction immediately after or by 24 h after surgery. Three patients with CRD had an increase in creatinine of >44 micromol litre(-1) at 48 and 72 h after surgery in the setting of volume depletion (acute blood loss in two patients and early ileus in one). Renal function subsequently improved.
  
  
  CONCLUSIONS
  HEA, per se, when carefully managed does not appear to predispose patients with CRD to acute renal failure after THR.
authors.affiliation: Department of Anesthesiology and Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA. sharrockn@hss.edu
authors.forename: N E
authors.initials: NE
authors.lastname: Sharrock
authors.forename: B
authors.initials: B
authors.lastname: Beksac
authors.forename: E
authors.initials: E
authors.lastname: Flynn
authors.forename: G
authors.initials: G
authors.lastname: Go
authors.forename: A Gonzalez
authors.initials: AG
authors.lastname: Della Valle
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000379:methods*; D000886:Anthropometry; D019644:Arthroplasty, Replacement, Hip; D003404:Creatinine / Q000097:blood; D000077324:Crystalloid Solutions; D005260:Female; D006400:Hematocrit; D006801:Humans; D007023:Hypotension, Controlled / Q000009:adverse effects*; D007430:Intraoperative Care / Q000379:methods; D007552:Isotonic Solutions / Q000008:administration & dosage; D007674:Kidney Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D003404:Creatinine