Norepinephrine for hypotensive vasodilatation after cardiac surgery: impact on renal function

Byline: Hiroshi Morimatsu (1), Shigehiko Uchino (1), John Chung (2), Rinaldo Bellomo (1), Jai Raman (2), Brian Buxton (2) Keywords: Norepinephrine; Cardiac surgery; Creatinine; Acute renal failure; Shock; Cardiopulmonary bypass Abstract: Objectives Norepinephrine use in patients after cardiac surgery is controversial because of the fear that norepinephrine might decrease kidney function through regional vasoconstriction. Accordingly, we studied the renal effects of norepinephrine use for hypotensive vasodilatation after cardiac surgery. Design and setting Retrospective controlled study in the cardiothoracic ICU of tertiary hospital. Patients 100 cardiac surgery patients with post-operative hypotensive vasodilatation and 100 control cardiac surgery patients. Intervention Treatment of hypotension (MAP Measurements and results We collected data on demographic and surgical characteristics, haemodynamics, serum creatinine and mortality. Just after surgery the norepinephrine group had a significantly higher mean central venous pressure, lower mean arterial pressure, and lower systemic vascular resistance index with a similarly elevated mean cardiac index. Despite norepinephrine administration at a mean peak dose of 7.3+-6.4 Aug/min the mean post-operative change in creatinine was not different between two groups on days 0, 2 or 4 after surgery. Conclusions Norepinephrine does not increase post-operative serum creatinine concentrations in patients with hypotensive vasodilatation after cardiac surgery. Concerns related to its potential adverse effects on the kidney function in this setting appear unjustified. Author Affiliation: (1) Departments of Intensive Care and Medicine, Austin and Repatriation Medical Centre, Melbourne University, Studley Road, Heidelberg, 3084, Melbourne, Victoria, Australia (2) Department of Cardiothoracic Surgery, Austin and Repatriation Medical Centre, Studley Road, Heidelberg, 3084, Melbourne, Victoria, Australia Article History: Received Date: 10/10/2002 Accepted Date: 14/04/2003 Online Date: 22/05/2003 Article note: This study was supported by the Austin and Repatriation Medical Centre Intensive Care Research Fund