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Perioperative renal protection

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https://www.readbyqxmd.com/read/27833481/cardiac-and-renal-protective-effects-of-dexmedetomidine-in-cardiac-surgeries-a-randomized-controlled-trial
#1
A S Ammar, K M Mahmoud, Z A Kasemy, M A Helwa
BACKGROUND: Cardiac and renal injuries are common insults after cardiac surgeries that contribute to perioperative morbidity and mortality. Dexmedetomidine has been shown to protect several organs against ischemia/reperfusion-(I/R) induced injury. We performed a randomized controlled trial to assess the effect of dexmedetomidine on cardiac and renal I/R injury in patients undergoing cardiac surgeries. MATERIALS AND METHODS: Fifty patients scheduled for elective cardiac surgeries were randomized to dexmedetomidine group that received a continuous infusion of dexmedetomidine initiated 5 min before cardiopulmonary bypass (1 μg/kg over 15 min, followed by 0...
October 2016: Saudi Journal of Anaesthesia
https://www.readbyqxmd.com/read/27775553/a-perioperative-clinical-pathway-can-dramatically-reduce-failure-to-rescue-rates-after-cytoreductive-surgery-for-peritoneal-carcinomatosis-a-retrospective-study-of-666-consecutive-cytoreductions
#2
Guillaume Passot, Delphine Vaudoyer, Laurent Villeneuve, Florent Wallet, Annie-Claude Beaujard, Gilles Boschetti, Pascal Rousset, Naoual Bakrin, Eddy Cotte, Olivier Glehen
OBJECTIVE: To determine whether a perioperative, standardized clinical pathway could impact the failure-to-rescue rate after cytoreductive surgery (CRS) for peritoneal carcinomatosis (PC) in a tertiary center. SUMMARY OF BACKGROUND DATA: Morbidity and mortality remain significant after CRS for PC. Clinical pathways have been associated with better outcomes after surgery. The failure-to-rescue rate is a useful metric for evaluating quality in surgery. MATERIALS AND METHODS: This study included 666 patients that received CRS for PC between 2009 and 2014...
April 11, 2016: Annals of Surgery
https://www.readbyqxmd.com/read/27699971/robot-assisted-approach-improves-surgical-outcomes-in-obese-patients-undergoing-partial-nephrectomy
#3
Ercan Malkoc, Matthew J Maurice, Onder Kara, Daniel Ramirez, Ryan J Nelson, Peter A Caputo, Pascal Mouracade, Robert Stein, Jihad H Kaouk
OBJECTIVES: To assess the impact of approach on surgical outcomes in otherwise healthy obese patients undergoing partial nephrectomy for small renal masses. PATIENTS AND METHODS: Using our institutional partial nephrectomy database, we abstracted data on otherwise healthy (Charlson comorbidity score ≤1 and bilateral kidneys), obese patients (body mass index >30 kg/m(2) ) with small renal masses (<4 cm) treated between 2011 and 2015. The primary outcomes were intra-operative transfusion, operating time, length of hospital stay (LOS), and postoperative complications...
October 4, 2016: BJU International
https://www.readbyqxmd.com/read/27650341/organ-protection-during-aortic-cross-clamping
#4
REVIEW
Kak Khee Yeung, Menno Groeneveld, Joyce Ja-Ning Lu, Pepijn van Diemen, Vincent Jongkind, Willem Wisselink
Open surgical repair of an aortic aneurysm requires aortic cross-clamping, resulting in temporary ischemia of all organs and tissues supplied by the aorta distal to the clamp. Major complications of open aneurysm repair due to aortic cross-clamping include renal ischemia-reperfusion injury and postoperative colonic ischemia in case of supra- and infrarenal aortic aneurysm repair. Ischemia-reperfusion injury results in excessive production of reactive oxygen species and in oxidative stress, which can lead to multiple organ failure...
September 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27642570/from-pre-existing-renal-failure-to-perioperative-renal-protection-the-anesthesiologist-s-dilemmas
#5
REVIEW
Rudin Domi, Gentian Huti, Hektor Sula, Nehat Baftiu, Myzafer Kaci, Artan Bodeci, Albert Pesha
CONTEXT: Pre-existing renal dysfunction presents specific features that anesthesiologists must deal with. Anesthesia and renal function are connected and can interfere with each other. Induced hypotension anesthesia and the toxic effects of anesthetic drugs can further deteriorate renal function. EVIDENCE ACQUISITION: Decreased renal function can prolong anesthetic drug effects by decreased elimination of these drugs. Anesthesia can deteriorate renal function and decreased renal function can interfere with drug elimination leading to their prolonged effect...
June 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27583900/isoflurane-compared-with-fentanyl-midazolam-based-anesthesia-in-patients-undergoing-heart-transplantation-a-retrospective-cohort-study
#6
Che-Hao Hsu, Yung-Chi Hsu, Go-Shine Huang, Chih-Cherng Lu, Shung-Tai Ho, Wen-Jinn Liaw, Yi-Ting Tsai, Chih-Yuan Lin, Chien-Sung Tsai, Tso-Chou Lin
Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded...
August 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27578577/-protective-effects-of-high-dose-ulinastatin-on-vital-organs-in-patients-receiving-total-arch-replacement-for-type-a-aortic-dissection
#7
Xian-Yue Wang, Wen-Peng Dong, Guang Tong, Sheng-Hui Bi, Ben Zhang, Hua Lu, Xiao-Wu Wang, Wei-da Zhang
OBJECTIVE: To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection. METHODS: Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group)...
August 20, 2016: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/27566799/arterial-clamping-increases-central-renal-cryoablation-efficacy-an-animal-study
#8
Lasse L Nonboe, Tommy K Nielsen, Søren Høyer, Ole Graumann, Jørgen Frøkiær, Michael Borre
INTRODUCTION: The minimally invasive treatment of small renal masses with cryoablation has become increasingly widespread during the past 15 years. Studies with long-term follow-up are beginning to emerge, showing good oncological control, however, tumors with a central and endophytic location seem to possess an increased risk of treatment failure. Such tumors are likely to be subjected to a high volume of blood giving thermal protection to the cancerous cells. Arterial clamping during freezing might reduce this effect but at the same time subject the kidney to ischemia...
August 25, 2016: Technology in Cancer Research & Treatment
https://www.readbyqxmd.com/read/27528265/padua-and-r-e-n-a-l-nephrometry-scores-correlate-with-perioperative-outcomes-of-robot-assisted-partial-nephrectomy-analysis-of-the-vattikuti-global-quality-initiative-in-robotic-urologic-surgery-gqi-rus-database
#9
Riccardo Schiavina, Giacomo Novara, Marco Borghesi, Vincenzo Ficarra, Rajesh Ahlawat, Daniel A Moon, Francesco Porpiglia, Benjamin J Challacombe, Prokar Dasgupta, Eugenio Brunocilla, Gaetano La Manna, Alessandro Volpe, Hema Verma, Giuseppe Martorana, Alexandre Mottrie
OBJECTIVES: To evaluate and compare the correlations between Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) and R.E.N.A.L. [Radius (tumour size as maximal diameter), Exophytic/endophytic properties of the tumour, Nearness of tumour deepest portion to the collecting system or sinus, Anterior (a)/posterior (p) descriptor and the Location relative to the polar line] nephrometry scores and perioperative outcomes and postoperative complications in a multicentre, international series of patients undergoing robot-assisted partial nephrectomy (RAPN) for masses suspicious for renal cell carcinoma (RCC)...
August 16, 2016: BJU International
https://www.readbyqxmd.com/read/27522513/the-effect-of-spironolactone-on-acute-kidney-injury-after-cardiac-surgery-a-randomized-placebo-controlled-trial
#10
Rubén Barba-Navarro, Mirell Tapia-Silva, Carlos Garza-Garcia, Salvador López-Giacoman, Ipsae Melgoza-Toral, Armando Vázquez-Rangel, Silvana Bazúa-Valenti, Norma Bobadilla, Michael Wasung de Lay, Francisco Baranda, Lakhmir S Chawla, Gerardo Gamba, Magdalena Madero
BACKGROUND: Cardiac surgery-related acute kidney injury (AKI) is a common postoperative complication that greatly increases morbidity and mortality. There are currently no effective interventions to prevent AKI associated with cardiac surgery. Experimental data have shown that administration of the mineralocorticoid receptor blocker spironolactone prevents renal injury induced by ischemia-reperfusion in rats. The objective of this study was to test whether short-term perioperative administration of oral spironolactone could reduce the incidence of AKI in cardiac surgical patients...
August 10, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
https://www.readbyqxmd.com/read/27521822/somatosensory-evoked-potentials-and-electroencephalography-during-carotid-endarterectomy-predict-late-stroke-but-not-death
#11
Natalie Domenick Sridharan, Rabih A Chaer, Partha D Thirumala, Jeffrey Balzer, Becky Long, Edith Tzeng, Michel S Makaroun, Efthymios D Avgerinos
BACKGROND: Late stroke and death rates are anticipated to be higher in patients undergoing carotid endarterectomy (CEA) compared with healthy counterparts. However, little is known regarding predictors other than the baseline comorbidities. We have recently shown that dual intraoperative somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) monitoring improves the ability to predict perioperative strokes. We seek to determine if dual intraoperative monitoring (IOM) can further predict long-term strokes and death...
August 10, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27440000/perioperative-outcomes-of-coronary-artery-bypass-graft-in-renal-transplant-recipients-in-the-united-states-results-from-the-nationwide-inpatient-sample
#12
James E Tooley, Daniel D Bohl, Sanjay Kulkarni, Manuel I Rodriguez-Davalos, Abeel Mangi, David C Mulligan, Peter S Yoo
BACKGROUND: Cardiovascular disease is the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD). In fact, death from cardiovascular disease is the number one cause of graft loss in kidney transplant (KTx) patients. Compared to patients on dialysis, CKD patients with KTx have increased quality and length of life. It is not known, however, whether outcomes of coronary artery bypass graft (CABG) surgery differ between CKD patients with KTx or on dialysis...
October 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27423055/effect-of-moderately-intense-perioperative-glucose-control-on-renal-allograft-function-a-pilot-randomized-controlled-trial-in-renal-transplantation
#13
Justin Parekh, Garrett R Roll, Steven Wisel, Robert J Rushakoff, Ryutaro Hirose
Recipient diabetes accounts for ~34% of end stage renal disease in patients awaiting renal transplantation and has been linked to poor graft function. We conducted a single center, open label, randomized controlled trial to determine if moderately intense glucose control during allograft reperfusion would reduce the incidence of poor graft function. Adult diabetics undergoing deceased donor renal transplant were randomized to moderately intense glucose control (n=30) or standard control (n=30). The primary outcome was poor graft function (dialysis within seven days of transplant or failure of serum creatinine to fall by 10% for three consecutive days)...
July 16, 2016: Clinical Transplantation
https://www.readbyqxmd.com/read/27410428/predicting-complications-in-partial-nephrectomy-for-t1a-tumours-does-approach-matter
#14
Daniel Ramirez, Matthew J Maurice, Peter A Caputo, Ryan J Nelson, Önder Kara, Ercan Malkoç, Jihad H Kaouk
OBJECTIVES: To assess differences in complications after robot-assisted (RAPN) and open partial nephrectomy (OPN) among experienced surgeons. PATIENTS AND METHODS: We identified patients in our institutional review board-approved, prospectively maintained database who underwent OPN or RAPN for management of unifocal, T1a renal tumours at our institution between January 2011 and August 2015. The primary outcome measure was the rate of 30-day overall postoperative complications...
December 2016: BJU International
https://www.readbyqxmd.com/read/27344977/impact-of-antioxidant-supplementations-on-cardio-renal-protection-in-cardiac-surgery-an-updated-and-comprehensive-meta-analysis-and-systematic-review
#15
REVIEW
Sadegh Ali-Hassan-Sayegh, Seyed Jalil Mirhosseini, Mahbube Tahernejad, Parisa Mahdavi, Azadeh Shahidzadeh, Ali Akbar Karimi-Bondarabadi, Ali-Mohammad Dehghan, Elham Rahimizadeh, Fatemeh Haddad, Zahra Ghodratipour, Zahra Sarrafan-Chaharsoughi, Arezoo Shahidzadeh, Azam Ghanei, Mohammadreza Lotfaliani, Mohamed Zeriouh, Alexander Weymann, Aron-Frederik Popov, Anton Sabashnikov
This systematic review with meta-analysis sought to determine the strength of evidence in terms of the impact of common antioxidant supplementations, such as N-acetylcysteine (NAC), vitamin C, and polyunsaturated fatty acids (PUFA) on perioperative outcomes after cardiac surgery with particular focus on the incidence of atrial fibrillation (AF) and acute kidney injury (AKI) with associated mortality. A total of 29 trials were identified that reported incidence of AF and 17 trials that reported incidence of AKI...
October 2016: Cardiovascular Therapeutics
https://www.readbyqxmd.com/read/27229666/total-aortic-arch-repair-risk-factor-analysis-and-follow-up-in-199-patients
#16
Andreas Martens, Erik Beckmann, Tim Kaufeld, Julia Umminger, Felix Fleissner, Nurbol Koigeldiyev, Heike Krueger, Jakob Puntigam, Axel Haverich, Malakh Shrestha
OBJECTIVES: Aortic arch surgery is associated with substantial perioperative risks. New prostheses as well as novel perfusion techniques have been developed to reduce the risks of these procedures. The routine application of these new techniques warrants reassessment of risk factors of aortic arch repair. METHODS: Between April 2010 and December 2015, 199 patients [61% male, median age 63 years (interquartile range 52-70 years)] underwent total aortic arch repair in our institution...
May 26, 2016: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27167445/restrictive-versus-liberal-transfusion-strategy-in-the-perioperative-and-acute-care-settings-a-context-specific-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#17
Frédérique Hovaguimian, Paul S Myles
BACKGROUND: Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. METHODS: The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients...
July 2016: Anesthesiology
https://www.readbyqxmd.com/read/27154155/emergency-off-pump-coronary-artery-bypass-graft-surgery-for-patients-on-preoperative-intraaortic-balloon-pump
#18
Hisato Ito, Toru Mizumoto, Hironori Tempaku, Kazuya Fujinaga, Yasuhiro Sawada, Satoshi Teranishi, Hideto Shimpo
BACKGROUND: The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. METHODS: One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87)...
September 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27152759/perioperative-prostaglandin-e1-infusion-in-living-donor-liver-transplantation-a-double-blind-placebo-controlled-randomized-trial
#19
Viju Kumar Bharathan, Biju Chandran, Unnikrishnan Gopalakrishnan, Christi Titus Varghese, Ramachandran N Menon, Dinesh Balakrishnan, O V Sudheer, Puneet Dhar, Sudhindran Surendran
The role of prostaglandin E1 (PGE1) infusion in improving early graft function has not been well defined, especially in the scenario of living donor liver transplantation (LDLT). We designed a randomized, double-blind, placebo-controlled trial to evaluate the role of perioperative PGE1 infusion in LDLT. Patients in the study arm received PGE1 (alprostadil) at the rate of 0.25 μg/kg/hour, starting at 1 hour after portal venous reperfusion, and continued for 96 hours. The primary endpoint was early allograft dysfunction (EAD)...
August 2016: Liver Transplantation
https://www.readbyqxmd.com/read/27143905/cardiac-renal-and-neurological-benefits-of-preoperative-levosimendan-administration-in-patients-with-right-ventricular-dysfunction-and-pulmonary-hypertension-undergoing-cardiac-surgery-evaluation-with-two-biomarkers-neutrophil-gelatinase-associated-lipocalin
#20
José Luis Guerrero-Orriach, Daniel Ariza-Villanueva, Ana Florez-Vela, Lourdes Garrido-Sánchez, María Isabel Moreno-Cortés, Manuel Galán-Ortega, Alicia Ramírez-Fernández, Juan Alcaide Torres, Concepción Santiago Fernandez, Isabel Navarro Arce, José María Melero-Tejedor, Manuel Rubio-Navarro, José Cruz-Mañas
PURPOSE: To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. METHODS: This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan...
2016: Therapeutics and Clinical Risk Management
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