role of fenoldopam in renal protection during major vascular surgery

Despite the progress in surgical and anesthetic management, decreased renal function is still observed after abdominal infrarenal aortic surgery and remains problem in postoperative period. In the present study, it is a comparison between the effects of fenoldopam and frusemide in renal protection during infrarenal aortic cross clamping [ACC] surgery. 30 patients undergoing infrarenal aortic cross clamping surgery were divided into two group, fenoldopam group; patient received infusion of fenoldopam 0.1 micro g/Kg/min prior to surgical incision, and frusemide group; infusion of frusemide 0.6 micro g/kg/min. Direct measurements were obtained which included fluid balance, haemodynamic changes, urinary micro albumin concentration, urine output and by using standard formulas we obtained the indirect measurements which include creatinine clearance values and fractional excretion of sodium values. There was no significant statistical difference in haemodynamics detected between the two groups. A significant decrease in creatinine clearance in frusemide group occurred during the aortic cross-clamping period [period C] and during the first four hours post-declamping [period D]. This significant decrease returned gradually to normal by day 2 postoperatively. In contrast, fenoldopam preserved creatinine clearance through out the study time. There was significant increase in fractional excretion of sodium, more in the frusemide group than the fenoldopam group. There was a statistically significant increase in urine output in fenoldopam group during period D compared to baseline, while there was significantly increased in urine output in frusemide group during the period B [preclamped], period C and period D compared to baseline. The urine micro- albumin showed significant increase in both groups which started earlier in the frusemide group [during ACC]. In the present study we found that intravenous infusion of fenoldopam is more effective than frusemide as a renal protector. It preserved the creatinine clearance during the perioperative period for patient with normal renal function undergoing elective repair of infra-renal aortic aneurysm

efficacy of combined superficial and deep cervical plexus block for anterior cervical discectomy

Major neck surgeries are conventionally performed under general anesthesia, but recent evidence suggests that regional anesthesia is an effective adjuvant to general anesthesia. The present study was designed to assess the efficiency of combined unilateral superficial and deep cervical plexus blocks with general anesthesia in patients undergoing anterior cervical discectomy. 30 patients undergoing to do anterior cervical discectomy surgery were divided into two group, general anesthesia group [GA]; patient received general anesthesia alone, and combined group [GC]; patients received combined general anesthesia and superficial and deep cervical blockade. Measurements were obtained which include intraoperative haemodynamics, intra and postoperative analgesic efficacy and hormonal stress response. The number of patients requiring supplemental analgesic and muscle relaxant was lower in GC than GA group. The SBP and HR were significantly lower during intra and postoperative period in GC group than the base line and the other GA group. VAS was significantly lower in PACU in GC group than GA group but after 12 and 24 hours, there was no statistical difference between the two groups. The time of initial morphine administration was significantly longer in GC group then the GA group and the total morphine administration was significantly lower in GC group than in GA group. The blood glucose and cortisol level were statistically significantly higher postoperatively compared to the base line. But this increase was clinically insignificant. Our results show that unilateral superficial and deep cervical plexus block performed with a 0.5% ropivacaine significantly reduced intraoperative requirements of anesthetics and analgesics in patients undergoing anterior cervical discectomy. And, the Postoperative analgesics were significantly reduced in combined group than the general anesthesia group