The two prior hypotheses of the study were that, among a high risk population of patients who were hypertensive, who had diabetes and who underwent elective general surgical treatment, the duration of intraoperative hypotension and hypertension (>20 millimeters of mercury above or below the preoperative base line) and intraoperative administration of <300 milliliters per hour of saline solution containing fluids would identify patients at higher risk for postoperative renal dysfunction. Among those who had an intraoperative mean arterial pressure (MAP) that fell more than 20 millimeters of mercury below the base line, 15 per cent of those with fall of MAP lasting for ≥60 minutes had postoperative renal dysfunction, whereas those with drops in pressure lasting for <60 minutes did not sustain increased postoperative renal dysfunction. Patients who had intraoperative MAP rise to >20 millimeters of mercury above the preoperative base line value for >30 minutes also had twice the rate of postoperative renal dysfunction. Fifteen per cent of the patients who received <300 milliliters per hour of isotonic saline-like fluids had postoperative renal dysfunction, significantly more than the 8 per cent of those who received ≥300 milliliters per hour. Two intraoperative events also significantly increased postoperative renal dysfunction rates: cardiac arrest and the drainage of massive ascites. Patients with decompensated congestive heart failure at admission to the hospital had significantly increased postoperative renal dysfunction; these patients probably should not undergo an operation unless it is an emergency. All of the patients, regardless of the magnitude of the operation and of its projected length or type of anesthesia, should be given >300 milliliters per hour of isotonic saline-like solutions.
|Original language||English (US)|
|Number of pages||7|
|Journal||Surgery Gynecology and Obstetrics|
|State||Published - Jan 1 1989|
ASJC Scopus subject areas
- Obstetrics and Gynecology