Lesión renal aguda / Acute Kidney Injury

Noviembre 9, 2015. No. 2140

Hipotensión intraoperatoria: un factor causal descuidado en la lesión renal aguda adquirida en el hospital; una experiencia del Sistema de Salud de la Clínica Mayo revisitado. Intraoperative hypotension - a neglected causative factor in hospital-acquired acute kidney injury; a Mayo Clinic Health System experience revisited. Onuigbo MA, Agbasi N. J Renal Inj Prev. 2015 Sep 1;4(3):61-7. doi: 10.12861/jrip.2015.13. eCollection 2015. Abstract Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function. In this review, we examine the basis for this consensus, exposing some of the flaws of the clinical study data upon which this prevailing consensus is based. We then describe our experiences in the last decade at the Mayo Clinic Health System, Eau Claire, in Northwestern Wisconsin, USA, with two selected case presentations to highlight the contribution of IH as a potent yet preventable cause of post-operative AKI. We further highlight the causative although neglected role of IH in precipitating postoperative AKI in chronic kidney disease (CKD) patients. We show additional risk factors associated with this syndrome and further make a strong case for the elimination of IH as an achievable mechanism to reduce overall, the incidence of hospital acquired AKI. We finally posit that as the old saying goes, prevention is indeed better than cure. KEYWORDS: Acute kidney injury; Chronic kidney disease; Estimated glomerular filtration rate; Renal replacement therapy; Serum creatinine trajectory PDF   Lesión renal aguda Acute Kidney Injury Daniel Patschan, Gerhard Anton Müller Journal of Injury and Violence Research, Vol 7, No 1 (2015) Abstract Acute kidney injury is a frequent and serious complication in hospitalized patients. Mortality rates have not substantially been decreased during the last 20 years. In most patients AKI results from transient renal hypoperfusion or ischemia. The consequences include tubular cell dysfunction/damage, inflammation of the organ, and post-ischemic microvasculopathy. The two latter events perpetuate kidney damage in AKI. Clinical manifestations result from diminished excretion of water, electrolytes, and endogenous / exogenous waste products. Patients are endangered by cardiovascular complications such as hypertension, heart failure, and arrhythmia. In addition, the whole organism may be affected by systemic toxification (uremia). The diagnostic approach in AKI involves several steps with renal biopsy inevitable in some patients. The current therapy focuses on preventing further kidney damage and on treatment of complications. Different pharmacological strategies have failed to significantly improve prognosis in AKI. If dialysis treatment becomes mandatory, intermittent and continuous renal replacement therapies are equally effective. Thus, new therapies are urgently needed in order to reduce short- and long-term outcome in AKI. In this respect, stem cell-based regimens may offer promising perspectives. PDF Incidencia de la injuria renal aguda en unidad de paciente crítico y su mortalidad a 30 días y un año Incidence and consequences of acute kidney injury among patients admitted to critical care units Boltansky A, Bassa C, Melani S, Sepúlveda A, Maldonado I, Postigo J, Sotta E, Vidueira P, Cavagnaro C, Cavada G, Benavente C, Villamizar G, Vukusich A, Irarrázabal CE. Rev Med Chil. 2015 Sep;143(9):1114-20. doi: 10.4067/S0034-98872015000900003. Abstract BACKGROUND: Acute Kidney Injury (AKI) increases morbidity, mortality and hospital stay in critical patients units (CPU).AIM: To determine the incidence and mortality of AKI in CPU. MATERIAL AND METHODS: Review of electronic medical records of 1,769 patients aged 61 ± 20 years (47% males) discharged from a CPU during one year. Acute Kidney Injury diagnosis and severity was established using the Acute Kidney Injury Network (AKIN) criteria. RESULTS: A history of hypertension and Diabetes Mellitus was present in 44 and 22% of patients, respectively. APACHE II and SOFA scores were 14.6 ± 6.8 and 3.6 ± 2.1 respectively. AKI incidence was 28.9% (stage I, 16.7%, stage II, 5.3% and stage III, 6.9%). Mortality during the first 30 days and during the first year was 8.1 and 20.0% respectively. Patients with stage III AKI had the highest mortality (23.8 and 40.2% at 30 days and one year respectively). Compared with patients without AKI, the Odds ratio for mortality at 30 days and one year of patients with AKI stage III was 3.7 and 2.5, respectively. CONCLUSIONS: Thirty percent of patients admitted to UPC develop an AKI, which influences 30 days and one year mortality. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Medwave: Últimos artículos publicados. Noviembre de 2015

A continuación le informamos sobre los artículos recientemente publicados en Medwave.


DEL EDITOR

Impacto y pertinencia en la revista: publicando en inglés y gran número de visitas únicas
Vivienne C. Bachelet

Medwave 2015 Nov;15(10):e6301
http://dx.doi.org/10.5867/medwave.2015.10.6301


RESÚMENES EPISTEMONIKOS

¿Es superior el clavo endomedular a la placa en pacientes con fractura de tibia distal extraarticular?
Jorge Cabrolier, Marcelo Molina (Chile)

Medwave 2015;15(Suppl 3):e6306
http://dx.doi.org/10.5867/medwave.2015.6306


REPORTE DE CASO

Púrpura de Henoch Schonlein asociada a picadura de abeja: reporte de caso
José Gálvez Olortegui, Mayita Álvarez Vargas, Juan Durand Vergara, Marisol Díaz Lozano, Tomas Gálvez Olortegui, Indira Armas-Ramírez, Julio Hilario Vargas (Perú)

Medwave 2015 Oct;15(9):e6297
http://dx.doi.org/10.5867/medwave.2015.09.6297


CARTA A LA EDITORA

Ensayos clínicos en países latinoamericanos
José Kelvin Gálvez Olortegui, Tomas Vladimir Gálvez Olortegui, Yudy Cley Cóndor Rojas (Perú)

Medwave 2015 Oct;15(9):e6294
http://dx.doi.org/10.5867/medwave.2015.09.6294


ARTÍCULO DE REVISIÓN

Periodontitis como determinante del inicio y progresión de la enfermedad de Huntington: revisión de la literatura
María Lourdes Rodríguez Coyago, Victoria Emilia Sánchez Temiño (Argentina)

Medwave 2015 Oct;15(9):e6293
http://dx.doi.org/10.5867/medwave.2015.09.6293



Para mayor información sobre envío de manuscritos, revisión y como publicar en Medwave escribir directamente a Rodrigo Núñez mailto:publishing@medwave.cl


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Ondansetron y prurit

Noviembre 7, 2015. No. 2138

Estudio comparativo con ondansetron i.v. y dosis subhipnóticas de propofol en el manejo de prurito inducido por sufentanil espinal en cesárea electiva The comparative study of intravenous Ondansetron and sub-hypnotic Propofol dose in control and treatment of intrathecal Sufentanil-induced pruritus in elective caesarean surgery. Hirmanpour A, Safavi M, Honarmand A, Hosseini AZ, Sepehrian M. J Res Pharm Pract. 2015 Apr-Jun;4(2):57-63. doi: 10.4103/2279-042X.155751. Abstract OBJECTIVE: Pruritus is a common and disturbing side effect of neuraxial opioids after cesarean section. The purpose of this study was to compare the efficacy of intravenous ondansetron and sub-hypnotic dose of propofol in control and treatment of intrathecal sufentanil induced pruritus in cesarean surgery. METHODS: Totally, 90 parturient with American Society of Anesthesiology physical status grade I-II, undergoing spinal anesthesia with 2.5 μg sufentanil and 10 mg bupivacaine 0.5% were enrolled to this randomized, prospective, double-blind study. The women were randomly assigned to two groups who received 8 mg ondansetron or 10 mg propofol to treat pruritus grade ≥3. The patient was evaluated after 5 min and in the lack of successful treatment, the doses of two drugs repeated and if the pruritus is on-going, the exact treatment with naloxone was done. FINDINGS: The incidence of pruritus was 69.3%. Both groups were well-matched. The peak time pruritus was 30-75 min after injection. The percentage of individuals consumed naloxone were 6.8% and 15.9% in ondansetron and propofol groups, respectively (P = 0.18). The mean score of satisfaction (according to visual analog scale criteria) was 9.09 ± 1.1 in ondansetron group and 9.3 ± 1.07 in the propofol group (P = 0.39). CONCLUSION: Ondansetrone and sub-hypnotic dose of propofol are both safe and well-tolerated. Due to their same efficacy in the treatment of intrathecal sufentanil-induced pruritus, they can be widely used in clinical practice. KEYWORDS: Caesarean surgery; Ondansetron; Propofol; intrathecal opioid; pruritus PDF Adminsitración profiláctica de ondansetron en la prevención de prurito y emesis inducidos por morfina espinal en cesárea Prophylactic administration of ondansetron in prevention of intrathecal morphine-induced pruritus and post-operative nausea and vomiting in patients undergoing caesarean section. Koju RB, Gurung BS, Dongol Y. BMC Anesthesiol. 2015 Feb 17;15:18. doi: 10.1186/1471-2253-15-18. Abstract BACKGROUND: Intrathecal morphine is commonly used for post caesarean analgesia. However, their use is frequently associated with the incidence of troublesome side effects such as nausea, vomiting and pruritus. Various mechanisms have been postulated for the opioid-induced pruritus, with a variety of medications with different mechanisms of actions formulated for the prevention and treatment. But, the results are inconsistent and hence the prevention and treatment of opioid-induced pruritus still remains a challenge. Ondansetron which is antiemetic, non-sedative and has no antianalgesic effect is an antagonist to 5-HT3 receptor, the receptor with which opioids interacts and imparts its effects. Ondansetron, thus, would be an attractive treatment strategy for both opioid-induced pruritus and post-operative nausea and vomiting. METHODS: After the approval from institutional review committee and written consent received from the patient, 50 healthy parturients of ASA I and II physical status undergoing caesarean section under spinal anaesthesia were enrolled for the study. They were randomly categorized into placebo group (2 ml normal saline) and treatment group (2 ml of 4 mg ondansetron), each group containing 25 patients. Pruritus and post-operative nausea and vomiting scores were recorded up to 24 hours after the administration of intrathecal morphine. Statistical analysis was performed using chi-square test. RESULTS: The incidence, severity and necessity of treatment for pruritus in the treatment group was significantly reduced compared to the placebo group (16% vs 88%). Similarly, the risk of post-operative nausea and vomiting in the treatment group was less compared to the placebo group (8% vs 56%). CONCLUSION: Prophylactic administration of ondansetron to parturients receiving intrathecal morphine for post-operative analgesia provides a significant reduction of intrathecal morphine-induced pruritus and nausea and vomiting. PDF  Comparación del efecto de droperidol y ondansetron profilácticos sobre el prurito inducido por morfina intratecal Comparison of droperidol and ondansetron prophylactic effect on subarachnoid morphine-induced pruritus. Brião FF, Horta ML, Horta BL, de Barros GA, Behrensdorf AP, Severo I, Nunes MA, Boabaid R, Real A. Braz J Anesthesiol.2015 Jul-Aug;65(4):244-8. doi: 10.1016/j.bjane.2013.11.005. Epub 2015 Apr 28. Abstract BACKGROUND AND OBJECTIVES: The prophylactic effect of ondansetron on subarachnoid morphine-induced pruritus is controversial, while evidence suggests that droperidol prevents pruritus. The aim of this study is to compare the effects of droperidol and ondansetron on subarachnoid morphine-induced pruritus. METHODS: 180 ASA I or II patients scheduled to undergo cesarean sections under subarachnoid anesthesia combined with morphine 0.2mg were randomized to receive, after the child's birth, metoclopramide 10mg (Group I - control), droperidol 2.5mg (Group II) or ondansetron 8mg (Group III). Postoperatively, the patients were assessed for pruritus (absent, mild, moderate or severe) or other side effects by blinded investigators. Patients were also blinded to their group allocation. The tendency to present more severe forms of pruritus was compared between groups. NNT was also determined. RESULTS: Patients assigned to receive droperidol [Proportional odds ratio: 0.45 (95% confidence interval 0.23-0.88)] reported less pruritus than those who received metoclopramide. Ondansetron effect was similar to metoclopramide [Proportional odds ratio: 0.95 (95% confidence interval 0.49-1.83)]. The NNT for droperidol and ondansetron was 4.0 and 14.7, respectively. CONCLUSIONS: Ondansetron does not inhibit subarachnoid morphine-induced pruritus. PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015

Anestesia para cesárea/Anesthesia for C-section

Noviembre 6, 2015. No. 2137

Anestesia espinal versus general para cesárea en pacientes con anemia de células falciformes Spinal versus general anesthesia for Cesarean section in patients with sickle cell anemia. Bakri MH, Ismail EA, Ghanem G, Shokry M. Korean J Anesthesiol. 2015 Oct;68(5):469-75. doi: 10.4097/kjae.2015.68.5.469. Epub 2015 Sep 30. Abstract BACKGROUND: Sickle cell anemia (SCA) increases the rate of maternal and fetal complications. This pilot study was designed to compare the maternal and fetal outcomes of spinal versus general anesthesia (GA) for parturients with SCA undergoing cesarean delivery. METHODS: Forty parturients with known SCA scheduled for elective Cesarean delivery were randomized into spinal anesthesia (n = 20) and GA groups (n = 20). Perioperative hemodynamic parameters were recorded. Postpartum complications were followed up. Opioid consumption was calculated. Blood loss during surgery and the number of patients who received intraoperative or postpartum blood transfusion were recorded. Patient satisfaction with the type of anesthesia was assessed. The Apgar score at 1 and 5 min, neonatal admission to the intensive care unit, and mortality were also recorded. RESULTS: Blood loss was significantly higher in the GA than spinal group (P = 0.01). However, the number of patients who received an intraoperative or postpartum blood transfusion was statistically insignificant. Significantly more patients developed intraoperative hypotension and bradycardia in the spinal than GA group. Opioid use during the first 24 h was significantly higher in the GA than spinal group (P < 0.0001). More patients had vaso-occlusive crisis in the GA than spinal group without statistical significance (P = 0.4). There was one case of acute chest syndrome in the GA group. No significant differences were observed in postoperative nausea and/or vomiting, patient satisfaction, or hospital length of stay. Neonatal Apgar scores were significantly better in the spinal than GA group at 1 and 5 min (P = 0.006 and P = 0.009, respectively). Neonatal intensive care admission was not significantly different between the two groups, and there was no neonatal mortality. CONCLUSIONS: Spinal anesthesia may have advantages over GA in parturients with SCA undergoing Cesarean delivery. KEYWORDS: Apgar score; Cesarean section; General anesthesia; Sickle cell anemia; Spinal anesthesia PDF

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org Copyright © 2015