Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2017
ReviewDiagnosis of cardiac surgery-associated acute kidney injury from functional to damage biomarkers.
Acute kidney injury (AKI) occurs in up to 30% after cardiac surgery and is associated with adverse outcome. Currently, cardiac surgery-associated acute kidney injury (CSA-AKI) is diagnosed by Kidney Disease: Improving Global Outcomes criteria based on creatinine and urine output. To detect and treat AKI earlier, various biomarkers have been evaluated. This review addresses the current position of the two damage biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and [TIMP-2] [IGFBP7] in clinical practice. ⋯ NGAL and urinary [TIMP-2] [IGFBP7], in combination with pretest assessment, are promising tools for early detection and treatment in CSA-AKI.
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Curr Opin Anaesthesiol · Feb 2017
ReviewMortality and cost of acute and chronic kidney disease after cardiac surgery.
Acute and chronic kidney diseases (AKI and CKD) have far-reaching implications for surgical patients in regards to postoperative outcomes and hospital cost. We review the recent literature on the effects of AKI and CKD on morbidity, mortality, and resource utilization among cardiac surgery patients. ⋯ AKI and CKD remain prevalent, morbid, and costly conditions for cardiac surgery patients. Better risk stratification, early diagnosis, and earlier interventions are needed to prevent the consequences of these diseases.
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Curr Opin Anaesthesiol · Feb 2017
ReviewDoes fluid management affect the occurrence of acute kidney injury?
To describe the potential impact of different fluid management strategies on renal outcomes in critically ill and postoperative patients. ⋯ Although synthetic colloids should be avoided in patients with or at risk of AKI, the renal efficacy of using albumin solutions and/or balanced crystalloids as alternatives to 0.9% sodium chloride in high-risk patients is yet to be confirmed or refuted. Improved goal-directed protocols, which minimize unnecessary fluid administration and reduce potentially harmful effects of fluid overload, need to be developed and tested.
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As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications. ⋯ The review summarizes the procedures now commonly performed by interventional pulmonologists and interventional radiologists. It discusses the anesthetic considerations for and common complications of these procedures to prepare anesthesiologists to safely care for these patients. Investigational techniques are also described.