ABSTRACT
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