The effect of mannitol and dopamine on the renal response to thoracic aortic cross-clamping.

Postoperative renal failure and insufficiency are important complications of operations that require thoracic aortic cross-clamping. Successful application of pharmacologic methods to protect renal function would be clinically useful. The ability of mannitol and dopamine to prevent renal dysfunction in a canine model of thoracic aortic cross-clamping was studied. Twenty animals were divided into four equal groups, and all underwent thoracic aortic cross-clamping for 60 minutes. An intra-aortic infusion of saline (control), mannitol, dopamine, or mannitol plus dopamine was started before, and continued during, the period of aortic occlusion. Glomerular filtration rate was significantly depressed 60 minutes after clamp release, and although there was some recovery in treated animals 150 minutes after clamp release, it remained significantly decreased (52% to 73% of baseline values, p less than 0.01). Renal blood flow was significantly reduced 60 minutes after clamp release, and there was no recovery in any group at 150 minutes (38% to 56% of baseline values, p less than 0.01). No significant differences in osmolar clearance or fractional excretion of sodium were evident between groups. These data reveal that the profound reductions in glomerular filtration and renal blood flow induced by thoracic aortic cross-clamping were not attenuated by mannitol or dopamine and suggest that efforts to protect renal function should be directed toward improving renal blood flow in the post-clamp period.