[Perioperative management following cardiovascular surgery in patients with renal insufficiency]

In recent years as the population becomes older, the number of patients undergoing cardiovascular surgery and thereafter suffering various complications has risen with increasing severity. Renal insufficiency is one of the characteristic complications. Most cardiovascular procedures require extracorporeal circulation. With extracorporeal circulation, kidney perfusion pressure and the perfusion volume decrease and this can result in potential renal tubule disorders following surgery. Therefore, it is important to prevent the postoperative aggravation of the renal function in patients with renal dysfunction before the induction of dialysis because they have a diminished renal reserve capacity and specific management is also required for patients on dialysis. The important points are as follows; (1) for the patient who is not on dialysis, it is important to maintain a sufficient blood pressure and prevent a shift to dialysis by avoiding exsiccation, (2) for the patient on dialysis, it is important to carefully evaluate the situation for each patient before resuming dialysis after surgery, (3) for both patient populations, it is important to always consider the dosage and dosage interval when any drugs are administered.