title: Effect of nicardipine on renal function after robot-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To investigate the renoprotective effect of nicardipine in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP) in a prospective trial. Superior visualization of the increasingly performed RALRP requires pneumoperitoneum and extreme head-down tilt, both of which are associated with a decrease in postoperative renal function. Nicardipine causes preferential dilation of the renal arterioles and attenuates renal dysfunction after cardiac surgery.
  
  
  METHODS
  After we obtained institutional review board approval, we randomly treated 100 patients undergoing RALRP with a continuous infusion of nicardipine at a rate of 0.5 microg/kg/min (nicardipine group, n = 50) or with normal saline (control group, n = 50) during surgery. We measured the serum creatinine (Cr) level and estimated glomerular filtration rate (eGFR) 1 day before surgery and the first and third postoperative days (POD 1 and 3, respectively).
  
  
  RESULTS
  Patients' characteristics and operative data were similar between groups. The serum Cr was significantly higher and the eGFR was significantly lower in the control group at POD 1. The number of patients having renal insufficiency (eGFR < 60 mL/min/1.73 m(2)) and abnormal serum creatinine level (>1.4 mg/dL) was significantly greater in the control group (9 vs 1, and 4 vs none, respectively) at POD 1.
  
  
  CONCLUSIONS
  Continuous infusion of low-dose nicardipine during RALRP seems to offset the deleterious effects of inevitable pneumoperitoneum and extreme head-down tilt on renal function in preserving the eGFR and attenuating the development of renal insufficiency in the immediate postoperative period.
authors.affiliation: Department of Anesthesiology and Pain Medicine, and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jang Eun
authors.initials: JE
authors.lastname: Cho
authors.forename: Jae Kwang
authors.initials: JK
authors.lastname: Shim
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Chang
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Oh
authors.forename: Hae Keum
authors.initials: HK
authors.lastname: Kil
authors.forename: Koon Ho
authors.initials: KH
authors.lastname: Rha
authors.forename: Young Lan
authors.initials: YL
authors.lastname: Kwak
mesh_terms: D000368:Aged; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects*; D006801:Humans; D007262:Infusions, Intravenous; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009529:Nicardipine / Q000627:therapeutic use*; D019990:Perioperative Care / Q000379:methods; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D011446:Prospective Studies; D011468:Prostatectomy / Q000295:instrumentation / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012016:Reference Values; D051437:Renal Insufficiency / Q000517:prevention & control; D018570:Risk Assessment; D012371:Robotics; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D003404:Creatinine; D009529:Nicardipine