Okay, what do you find to be a beneficial mechanism for renal "protection" during infra/supra renal clamping of the aorta. Lasix, mannitol, low dose dopamine, bicarbonate, fenoldopam, IVF etc... Any anecdotal success with a certain technique? Any pearls of wisdom?
What other factors (pre-op renal insufficiency, clamp time, low intravascular volume, etc..) can help one predict post-op renal failure?
thanks in advance, randy srna
Mar 1, '04
There are D1 receptors in the lungs, here are just a couple of the articles from medline that discuss them.
I thought the same thing at one time, so my first search was on whether there were D1 receptors in the pulmonary vasculature. Then I went on to try and find something with regard to stimulation and HPV. No studies that I can find, but that certainly does not mean they don't exist.
At any rate, there is a possibility that this is not what I was seeing. But, within minutes of starting the drug the first patient began to desaturate...I think to myself why is this happening? Nothing has changed EXCEPT that I have started fenoldopam. Next thought what about fenoldopam could do this?....well it is a vasodilator so....disruption of HPV. The next time I started it on a patient with pre-existing pulmonary disease I was on the alert...and once again the patient began to desaturate.
After a little internet research it seemed to me that it could very well be a disruption of HPV. But, it is only a hypothesis. Somebody want to test it?
Last edit by smiling_ru on Mar 1, '04