Kidney international
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Yoo and colleagues report a small but provocative randomized clinical trial to prevent acute kidney injury in the setting of cardiopulmonary bypass surgery. Their article describes a trial of 112 patients undergoing valvular surgery with cardiopulmonary bypass who were randomized to receive sevoflurane (an inhaled anesthetic) or propofol for general anesthesia. The use of propofol was associated with a significant decrease in the rate of postoperative acute kidney injury.
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Kidney international · Aug 2014
Randomized Controlled TrialAnesthetics influence the incidence of acute kidney injury following valvular heart surgery.
Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is lacking. Here we studied the effect of propofol anesthesia on the occurrence of acute kidney injury following heart surgery with cardiopulmonary bypass. One hundred and twelve patients who underwent valvular heart surgery were randomized to receive either propofol or sevoflurane anesthesia, both with sufentanil. ⋯ Serum interleukin-6 at 6 h after aorta cross-clamp removal, C-reactive protein at postoperative day 1, and segmented neutrophil counts at postoperative day 3 were also significantly lower in the propofol group. Thus, propofol anesthesia significantly reduced the incidence and severity of acute kidney injury in patients undergoing valvular heart surgery with cardiopulmonary bypass compared with sevoflurane. This beneficial effect of propofol may be related to its ability to attenuate the perioperative increase in proinflammatory mediators.