PROSPECTIVE-STUDY OF POSTOPERATIVE RENAL-FUNCTION IN OBSTRUCTIVE-JAUNDICE AND THE EFFECT OF PERIOPERATIVE DOPAMINE

A prospective study was undertaken to assess postoperative renal dysfunction in patients with obstructive jaundice and to determine the effectiveness of dopamine in reducing its incidence. A total of 23 patients undergoing surgical relief of obstructive jaundice (serum bilirubin level above 100 mu moll(-1)) were randomized into two groups. Those in the control group (n=10) received 3 litres 5 per cent dextrose intravenously during the 24 h before surgery plus a bolus of intravenous frusemide 1 mg kg(-1) at induction of anaesthesia. The second group (n=13) received a similar fluid and frusemide regimen plus an infusion of dopamine 3 mu g kg(-1) min(-1) starting at induction of anaesthesia and continuing for 48 h after surgery. Postoperative oliguria occurred in two of the ten patients in the control group and in three of the 13 given dopamine (P=0.74). No patient developed acute renal failure. There was no significant difference in mean levels of serum bilirubin, urea and creatinine, creatinine clearance and 24-h urinary output, on the day before and on days 1-5 after operation, between the two groups. It is concluded that, with careful preoperative resuscitation and control of fluid and electrolyte balance, the incidence of postoperative renal dysfunction in patients with obstructive jaundice is not as high as in some previous studies and is unaltered by administration of perioperative low-dose dopamine.