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Intensive care medicine · Apr 1998
Randomized Controlled Trial Clinical TrialIbuprofen does not impair renal function in patients undergoing infrarenal aortic surgery with epidural anaesthesia.
- A Brinkmann, W Seeling, C F Wolf, E Kneitinger, N Vogt, G Steinbach, K H Orend, P Radermacher, and M Georgieff.
- University Clinics Ulm, Department of Anaesthesiology, Germany.
- Intensive Care Med. 1998 Apr 1; 24 (4): 322328322-8.
ObjectiveTo investigate the effect of preoperative ibuprofen administration on renal function during and after infrarenal aortic surgery under thoracolumbar epidural anaesthesia (EPA).DesignA prospective randomised, double-blinded clinical study.SettingOperation room and intensive care unit in a university hospital.PatientsTwenty-six consecutive patients scheduled for elective infrarenal aortic surgery.InterventionsThe patients were prospectively randomised to receive 400 mg ibuprofen intravenously (i.v.) or a placebo aliquot before surgery.Measurements And ResultsWe assessed renal function by calculating creatinine clearance, and fractional sodium excretion before surgery (baseline), 1 h after cross-clamping (intraoperative), 6 h after cross-clamping (postoperative) and 24 h after cross-clamping (on the 1 st postoperative day). At each point in time, we additionally registered haemodynamics and determined the plasma concentration of 6-keto-PGF1alpha (stable metabolite of prostacyclin, PGI2), bicyclic PGE2 (stable metabolite of PGE1 E2), active renin, aldosterone and vasopressin by radioimmunoassays. Throughout the observation period the renal function parameters mostly remained within the normal range without a significant difference between ibuprofen- and placebo-treated patients (creatinine clearance: baseline 41 +/- 3 vs 38 +/- 6, intraoperative 57 +/- 8 vs 64 +/- 11, postoperative 64 +/- 9 vs 56 +/- 9, first postoperative day 43 +/- 5 vs 47 +/- 6 ml x min x m(-2), means +/- SEM). The plasma levels of 6-keto-PGF1alpha (68 +/- 8 vs 380 +/- 71* ng x l(-1)), bicyclic PGE2 (57 +/- 5 vs 88 +/- 9* ng x l(-1)) and vasopressin (14 +/- 7 vs 45 +/- 10* ng x l(-1), p < 0.0125), however, were significantly higher during the intraoperative period in the placebo-treated patients.ConclusionThe inhibition of endogenous prostaglandin release by ibuprofen does not substantially impair renal function during infrarenal aortic surgery under EPA.
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