Renoprotective Value of Dexmedetomidine-Ketamine Anesthetic Combination Compared to Propofol-Isoflurane in Renal Ischemia-Reperfusion Injury

Objectives: Perioperative acute kidney injury (AKI) frequently complicates renal ischemia and reperfusion injury (IRI), causing renal damage with no effective therapy. Anesthesia in such cases may be hazardous. The current study aimed to evaluate and compare the renoprotective value of the injected ketamine-dexmedetomidine combination to the inhaled isoflurane pre-medicated with propofol. Anesthetic efficacy was also considered in the comparison. Design: Randomized experimental trial. Setting: Animal house facility of Mansoura Urology and Nephrology Center. Subjects & Methods: 20 mongrel dogs were randomized into two groups: the Propofol-Isoflurane (Pro-Iso) Group, premedicated with propofol and maintained with isoflurane, and the Ketamine-Dexmedetomidine (Ket-Dex) Group, receiving a combination of ketamine and dexmedetomidine. Heart rate, respiratory rate, oxygen saturation, and noninvasive mean arterial blood pressure were monitored. Serum levels of creatinine, blood urea nitrogen, and kidney injury molecule-1 (KIM-1) were measured. Tissue malondialdehyde (MDA) was assessed, and histopathological assessment was done using a numerical scoring system. Results: The level of KIM-1 decreased 24 hours after the end of reperfusion in dogs anesthetized with the Pro-Iso group but remained significantly high for the Ket-Dex group. Renal MDA levels for Ket-Dex were significantly higher compared to Pro-Iso. The numerical scoring system showed significantly lower renal damage for the Pro-Iso group. Conclusion: When compared to the ketamine-dexmedetomidine combination, the combination of propofol and isoflurane provided more renal protection and effective anesthesia for dogs at risk of perioperative acute kidney injury caused by ischemia-reperfusion injury.