Comparison between different anaesthesia techniques for protecting renal function in children undergoing radical nephrectomy

Background
Although no standard paradigm has been approved yet superior than other in prevention of deterioration of renal function in children after radical nephrectomy (RN), early recognition of acute kidney injury (AKI) is a cornerstone. Cystatin C and neutrophil gelatinase-associated lipoprotein (NGAL) has shown to exhibit renal tubular stress earlier than ordinary biomarkers. The aim of the study was to compare between different anaesthesia techniques in protecting renal function in children undergoing RN.
Patients and methods
75 children (5–10 years) scheduled for RN were randomly categorized to: Dexmedetomidine (D) group, where DEX. 0.8 μg/kg was infused over 10 min as a loading dose, and then continued at a rate 0.4 μg/kg/h. Caudal (C) group, where 1 mL/kg dose of 0.25% bupivacaine was given and Placebo (P) group, where normal saline was given. Serum creatinine, creatinine clearance, Cystatin C and NGAL were assessed after induction of anaesthesia, 12 and 24 h postoperatively.
Results
Cystatin C and NGAL values decreased significantly in group D relative to group C and group P at all times of measurement. Urine output was significantly higher in the Dex. group. Serum creatinine and creatinine clearance showed no significant difference between the three studied groups at all times of measured. Dex members were more sedated and had lower objective pain scores relative to the other two groups.
Conclusions
Dexmedetomidine showed promising power in attenuation of renal stress and prevention of AKI in children undergoing RN when using cystatin C and NGAL biomarkers into clinical prediction schemes.