Renal Protection Protocol for Patients Undergoing Cardiac Surgery using Cardiopulmonary Bypass

Post-operative renal dysfunction is one of the established complications of cardio-pulmonary bypass (CPB). The authors present the hospital protocol for renal protection and their observations in patients with impaired renal function underwent for cardiac surgery using CPB.

All the patients with pre-operative creatinine more than 1.4mg% were subjected to this protocol. It comprises of optimal hydration and use of prophylactic renal protection drugs in the preoperative period. Zero-balance ultra-filtration along with maintenance of high mean arterial pressures, higher hematocrit, normothermia, optimal use of diuretics and use of a novel anaesthetic agent dexmeditomedine forms the intra-operative steps of our renal protection protocols. Optimal hydration is maintained in the postoperative period and use of nephrotoxic analgesics were avoided.

Combining the above strategies, authors have achieved very good results in maintaining normal renal function. Serum creatinine levels were came down in the post-operative period. None,of our patients required a post-operative haemodialysis.

A combined strategy which includes optimal peri-operative hydration, maintenance of high mean arterial pressures during CPB, zero-balance ultra filtration, use of dexmeditomedine have shown considerable results in alleviating creatinine increase post cardiac surgery in renal impaired patients.