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Renal Function after Coronary Artery Bypass Graft Using Dexmedetomidine

Open Journal of Anesthesiology 2013年第9期3卷 421-426页

作者： Alexandre Fabricio Martucci yara marcondes machado castiglia Botucatu College of Medicine Botucatu Brazil Ponta Grossa State University Ponta Grossa Brazi

Acute kidney injury (AKI) is defined by 0.3 mg/dL increase in serum creatinine (SCr) and is associated with higher incidence of postoperative mortality after coronary artery bypass graft (CABG). There are few clinical studies on the effect of dexmedetomidine (DEX) on renal function. We evaluated AKI after coronary artery bypass graft with and without cardiopulmonary bypass (CPB) under anesthesia with DEX. Method: In this retrospective study, we performed serial analysis of serum creatinine (SCr) up to 48 hours after surgery in 286 patients who underwent CABG. We tested the similarities between groups, evaluating patients separately for use of CPB and DEX. Each patient was evaluated for his or her SCr at the following points in time: preoperative, immediately postoperative, 24 hours postoperative, and 48 hours postoperative. Preoperative SCr was used as the baseline value for each patient. If the SCr increased ≥0.3 mg/dL in at least one of the periods, the patient was classified as having AKI. We also assessed the risk for AKI in patients with altered preoperative SCr (values between 1.1 to 2.0 mg/dL for women or 1.3 to 2.0 mg/dL for men) compared to patients with normal SCr. Results: The groups were similar for preoperative weight, age, and altered SCr. Patients were anesthetized with DEX and who underwent CPB exhibited higher incidence of AKI (p = 0.043). Without CPB, there was higher incidence of AKI after using DEX (p = 0.066). Conclusion: Anaesthesia with DEX increased the incidence of AKI after myocardial revascularization surgery in patients who underwent CPB.

关键词： Acute Kidney Injury Dexmedetomidine Cardiopulmonary Bypass Coronary Artery Bypass Graft

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Two-Hour Creatinine Clearance and Glomerular Filtration Rate Estimated from Serum Cystatin C and Creatinine in the Elderly to Preoperative Period

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Open Journal of Nephrology 2013年第4期3卷 184-188页

作者： Leopoldo Muniz da Silva Pedro Thadeu Galvao Vianna Mariana Takaku Glenio Bittencourt Mizubuti yara marcondes machado castiglia Department of Anaesthesiology Botucatu School of MedicineSao Paulo State University(UNESP)Sao PauloBrazil

Introduction: The utility of estimates of glomerular filtration rate based on creatinine and cystatin C serum levels to assess renal function in older surgical patients remains to be determined. Objective: To determine whether 2h-creatinine clearance (CrCl-2h) can be an adequate substitute for glomerular filtration rate estimates obtained by measuring serum cystatin C and creatinine in the elderly at preoperation. Methods: A total of 102 consecutive elder patients undergoing pre-anesthesia evaluation for routine surgeries were included. Study subjects were allocated into three groups: Group 1 (G1)—hypertensive diabetic patients, Group 2 (G2)—hypertensive patients, and Group 3 (G3)—non-hypertensive and non-diabetic patients. Two-hour urine collection was performed and CrCl-2h adjusted for ultrasonic residual bladder volume was estimated. GFR was estimated based on creatinine and cystatin C serum levels. Bland-Altman analysis was used to compare methods. Results: The mean difference between the evaluated methods and CrCl-2h was ·min-1·1.73 m-2 for Cys-GFR, and >20 mL·min-1·1.73 m-2 for Cr-GFR in all groups. CrCl-2h adjusted for ultrasonic residual bladder volume did not differ from non-adjusted CrCl-2h in none of the groups. Conclusion: Two-hour creatinine clearance was not an adequate substitute for GFR estimates based on creatinine and cystatin C serum levels in older patients at preoperation. The ultrasonic assessment of residual bladder volume had no significant influence on the calculation of two-hour creatinine clearance.

关键词： Renal Function Creatinine Clearance Cystatin C Elderly

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Renal function after laparoscopic cholecystectomy and analgesia with tramadol and dipyrone or ketorolac

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Health 2013年第11期5卷 35-41页

作者： Tiago Pechutti Medeiros Pedro Thadeu Galvao Vianna Leopoldo Muniz da Silva Lidia Raquel de Carvalho Gilberto Elias Wady Leandro Gobbo Braz yara marcondes machado castiglia Graduate Program in Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Department of Anesthesiology Botucatu Medical SchoolUNESP-Universidade Estadual PaulistaBotucatuBrazil Sao Luiz Hospital Sao PauloBrazil Department of Biostatics Institute of BiosciencesUNESP-Universidade Estadual PaulistaBotucatuBrazil Mercy Hospital Sao CarlosBrazil

Background: Laparoscopic cholecystectomy (LC) reduces surgical trauma and hospital stay, but requires effective and safe postoperative analgesia. This prospective and double-blind study investigated the effects of analgesia with tramadol combined with either dipyrone or ketorolac on the postoperative renal function of patients submitted to LC. Methods: Pre-and post-operatively (PO), estimated glomerular filtration rates (GFR), obtained by two formulas dependent on blood Cr and one on blood cystatin C values, and tubular enzymuria—alkaline phosphatase (AP), γ-glutamiltransferase (γ-GT)— were determined in well hydrated patients who underwent LC and analgesia with tramadol combined with either dipyrone (Dipyrone, n = 63) or ketorolac (Ketorolac, n = 63). Upon discharge from the post-anesthetic care unit (PACU), pain (through Verbal Numerical Scale—VNS) and need for rescue analgesia with morphine were evaluated. Results: There was hemodilution PO, which made GFR profile analysis more difficult—those dependent on Cr increased and statistically correlated, but those dependent on cystatin C did not change. There was a significant PO increase in AP in the Dipyrone and Ketorolac groups, and in the product of the both enzymes in the Ketorolac group. Upon PACU discharge, the Dipyrone group showed signifi cantly higher VNS scores than the Ketorolac group. All patients received morphine PO, and the total dose needed for pain control differed between groups, but without statistical significance. Conclusions: The association of tramadol with dipyrone or ketorolac in well hydrated patients submitted to LC had similar analgesic effectiveness in the PACU. Postoperatively, the effect on GFR may have been masked by hemodilution, and enzymuria was discreetly enhanced when ketorolac was used.

关键词： Kidney Function Tests Pneumoperitoneum Biological Markers Cystatin C Ketorolac Analgesia

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6％的羟乙基淀粉-高渗盐水在失血性休克狗复苏时的作用

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麻醉与镇痛 2012年第5期8卷 19-30页

作者： Joao M. P. Barros Paulo do Nascimento Joao Luiz P. Marinello Leandro G. Braz Lidia R. Carvalho Luiz A. Vane yara M. M. castiglia Jose R. C. Braz Department of Anesthesiology Botucatu Medical School Universidade Estadual Paulista Department of Biostatistics Institute of Biosciences Universidade Estadual Paulista Botucatu Brazil

背景血流动力学和全身氧输送的变化无法反映内脏低灌注，从而导致无法认识到对失血性休克的处理不足。液体复苏后扩容对改善失血性休克时全身和局部的氧供是必不可少的。我们假设，与传统的代血浆相比，应用少量的扩容剂7．5氯化钠／6... 详细信息

背景血流动力学和全身氧输送的变化无法反映内脏低灌注，从而导致无法认识到对失血性休克的处理不足。液体复苏后扩容对改善失血性休克时全身和局部的氧供是必不可少的。我们假设，与传统的代血浆相比，应用少量的扩容剂7．5氯化钠／6％羟乙基淀粉（hydroxyethyl *** saline，HHES）溶液，可能提供较少的全身氧输送和胃血流灌注。我们为失血的狗进行临床上严重出血时常用的固定量液体单次输注，分别观察HHES、乳酸林格液（1actatedRinger，LR）和6％羟乙基淀粉（hydroxyethyl starch，HES）溶液对血管内扩容、早期全身氧合和胃灌注的影响。方法30只狗，出血30ml／kg，保持平均动脉压在40～50mmHg，持续45分钟后，分3组进行复苏：LR组（n=10），输注3倍出血量的液体；HES组（平均分子量130KDa，替代级0．4）（n=10），输注出血量等量的液体；HHES组（n=10），以4ml／kg的速度输注。测定血管内容量增加情况（用Evans蓝和血红蛋白稀释）、血流动力学、全身氧合、静动脉CO2分压差（Pv-aco2）和胃黏膜-动脉血CO2分压差（Pco2间隙）变化，测定时间点为基础值、出血45分钟后以及液体复苏5分钟、45分钟、90分钟时。结果由于HHES的高扩容效力增加了血容量，但它对血管内容量的扩张作用是各溶液中最小的（P〈0．05）。3种溶液对血流动力学影响相同，但相对于LR组和HES组，HHES组相混合静脉血Po，更低，全身氧合、Pv-aco2和胃黏膜Pco2间隙更大（P〈0．05）。结论对狗进行按血压调节的失血性休克和固定容量的复苏，尽管HHES有高效扩容作用，但相比LR和HES，由于输注量受限，它的血管内容量扩充能力较小，全身氧合和胃血流灌注较差。

关键词：失血性休克羟乙基淀粉复苏后高渗盐水血流动力学影液体复苏胃血流灌注平均动脉压

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