Effect of Anesthesia on the Renal System
Effect of anesthesia on the renal system
Reversible decrease in renal blood flow, glomerular filtration rate, urinary flow, and sodium excretion occur during both regional and general anesthesia. Changes are generally less marked during regional anesthesia. Most of these changes are indirect and are mediated by autonomic and hormonal influences.
These effects can be at least partially overcome by maintenance of an adequate intravascular volume and a normal blood pressure. Only a few anesthetics (methoxyflurane and, theoretically, enflurane and sevoflurane) in high doses can cause specific renal toxicity.
In addition to the physiological changes associated with the neuroendocrine stress response to surgery, certain surgical procedures can significantly alter renal physiology. The pneumoperitoneum produced during laparoscopy produces an abdominal compartment syndrome-like state. The increase in intraabdominal pressure typically produces oliguria (or anuria) that is generally proportional to the insufflation pressures. Mechanisms include central venous compression (renal vein and vena cava); renal parenchymal compression; decreased cardiac output; and increases in plasma levels of renin, aldosterone, and ADH