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THE EFFECT OF INFRARENAL AORTIC CROSS CLAMPING AND DECLAMPING ON RENAL FUNCTION IN THE PIG
Author(s) -
Lalak N.,
Englund R.,
Morris R.,
Gibb D.,
Jacques T.
Publication year - 1995
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1995.tb00608.x
Subject(s) - medicine , renal artery , renal blood flow , clamp , renal function , cardiac output , blood flow , anesthesia , blood pressure , renal cortex , aorta , renal circulation , cardiology , circulatory system , kidney , hemodynamics , clamping , mechanical engineering , engineering
Renal insufficiency following periods of infrarenal aortic cross clamping has been reported by some investigators but not by others, and conflicting views have been expressed concerning the ability of renal autoregulation to overcome the adverse circulatory effects of cross clamping. The object of this study was to examine the blood flow distribution to four layers within the renal cortex (subcapsular to juxtamedullary) and measure global renal function following application and release of an aortic cross clamp after 90 min. Nine juvenile female pigs weighing 25 to 50 kg were anaesthetized and subjected to intensive physiological monitoring. Throughout the study the blood pressure and cardiac output were maintained as close as possible to control levels by fluid administration and varying the depth of anaesthesia. Renal cortical blood flow was estimated by means of radionuclide labelled microspheres and global renal function was determined by the measurement of creatinine clearance. The aortic cross clamp was applied for 90 min immediately distal to the renal arteries and proximal to the inferior mesenteric artery. Cardiovascular and renal parameters were recorded on four occasions during each experiment, prior to, 10 and 60 min after cross clamping, and 30 min after clamp release. No significant changes in cardiac output, systemic blood pressure or global renal function were recorded during the study. There was. however, a significant fall in renal blood flow following release of the aortic cross clamp but this was not associated with any significant redistribution of blood flow within the renal cortex. In the pigs studied, the application of an infrarenal aortic cross clamp did not have any adverse effects on the cardiovascular system or on global renal function. Following release of the clamp, however, there was a significant fall in renal cortical blood flow to which, presumably, could predispose postoperative renal insufficiency. It is proposed that intensive cardiovascular monitoring coupled with appropriate corrective therapy would substantially reduce the risk of this complication.