title: Evaluation of renal function under controlled hypotension in zero ischemia robotic assisted partial nephrectomy.
abstract: OBJECTIVE
  In partial nephrectomy with hilar clamping every minute of ischemia can impair renal function, thus great importance is having the controlled hypotension as a part of zero ischemia technique. The aim of the study is to evaluate the effects of hypotensive anesthesia on renal function, in patients undergoing robotic assisted partial nephrectomy (RAPN) , during surgery and at 3 months follow up.
  
  
  METHODS
  This is a prospective study of 100 patients, ASA 1-2, who underwent zero ischemia RAPN under controlled hypotension (CH) from December 2011 through to May 2013. Serum creatinine, BUN, estimated glomerular filtration rates (eGFR), fractional excretion of sodium (FSE) and technetium Tc 99m mercaptoacetyltriglycine (99mTC-MAG-3), renal scintigraphy with effective renal plasma flow (ERPF) were evaluated.
  
  
  RESULTS
  Mean duration of CH was 50 ± 4 minutes. Acute renal failure wasn't observed in any of the patients. A significant variation of eGFR during the procedure and 24 hours after surgery was observed. No significant variation of BUN and FSE was detected. Comparing preoperative ERPF of the operated kidney with ERPF 3 months after surgery, it decreased by 2%.
  
  
  CONCLUSIONS
  In patients with normal preoperative renal function CH didn't show any detrimental impact on renal function during and after robotic assisted partial nephrectomy.
authors.affiliation: Department of Anesthesiology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Ester
authors.initials: E
authors.lastname: Forastiere
authors.forename: Claudia
authors.initials: C
authors.lastname: Claroni
authors.forename: Maria
authors.initials: M
authors.lastname: Sofra
authors.forename: Giulia
authors.initials: G
authors.lastname: Torregiani
authors.forename: Marco
authors.initials: M
authors.lastname: Covotta
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Marchione
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Rocco
authors.initials: R
authors.lastname: Papalia
mesh_terms: D000368:Aged; D000758:Anesthesia; D005260:Female; D006801:Humans; D007023:Hypotension, Controlled / Q000379:methods*; D007511:Ischemia; D007668:Kidney / Q000601:surgery; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*