Traditionally, the surgeon has approached the jaundiced patient with all the caution born of experience, and rightly so. Regardless of whether the cause of the jaundice is surgically correctable, these patients frequently do not do well postoperatively. The deeper the jaundice, the more warranted the concern. When the kidneys are jaundiced and if there is any hemorrhage or other compromise to oxygenation, serious renal damage and even acute failure may result.
Recent contributors to the literature have suggested that mannitol, an osmotic agent better known for its use in kidney-function tests, may exert prophylaxis against postoperative renal failure,1 inluding renal failure in deeply jaundiced patients.2 A contribution to the September Archives of Pathology reports the testing of these suggestions. At King's College Hospital in London, Dawson and Stirling3 have shown that obstructive jaundice renders the kidney more sensitive to anoxia, and that mannitol exerts a considerable protective