Vasopressor Infusion During Prone Spine Surgery and Acute Renal Injury
Ehab Farag, MD, FRCA, FASA
Professor of Anesthesiology and Director of Clinical Research
Cleveland Clinic Lerner College of Medicine
|Ehab Farag, MD, FRCA, FASA|
The controversial effect of using vasopressors on developing acute kidney injury has motivated me to study the effect of vasopressor infusion during complex spine surgeries (Anesthesia and Analgesia 2019, Jan 14. Epub ahead of print). We obtained data on 1,814 adult surgeries for complex spine surgery performed at the Cleveland Clinic Main Campus between January 2005 and September 2014. In total, 689 patients (38%) were given vasopressor infusion for at least 30 minutes during surgery, while the remaining 1,125 patients (62%) were not administered any vasopressor infusion.
In addition, among the same cohort, 540 patients with and 540 patients without vasopressor infusion, were well matched across 32 potential confounding variables.
Among matched patients, the postoperative difference in mean estimated glomerular filtration rate was only 0.8 ml/min/1.73 m2.
Not only was there no statistical difference in filtration rate between the two groups, but the rate was maintained and, in some cases, even improved in patients with vasopressor infusion, which came as a surprise. There were also no increased odds of augmented acute kidney injury stage in patients who underwent vasopressor infusion.
Patients who received vasopressor infusion had more lengthy surgical times and were more prone to develop acute kidney injury, as they were received more blood transfusion infusion and hydroxyethyl starch(hextend) infusions than the control groups. Surprisingly, though, these patients had better urine output, which is a very good sign of a healthy kidney.
Therefore, based on the results of our study, avoiding fluid overload and maintaining renal perfusion pressure are the key factors to avoid acute kidney injury. In fact, avoiding vasopressor infusion to tolerate hypotension is probably a poor strategy.