Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Feb 2017
ReviewLong-term consequences of acute kidney injury in the perioperative setting.
Recent studies indicate that acute kidney injury (AKI) and chronic kidney disease (CKD) are interconnected syndromes. Although the majority of patients who suffer an episode of AKI will recover laboratory indices suggesting complete or near complete recovery of renal function, a significant portion of post-AKI survivors will develop major kidney events, including development of late-stage CKD, need for renal replacement therapies, and death. ⋯ AKI is a major cause for acute in-hospital mortality and development of both late-stage CKD and cardiovascular events. Perioperative care to prevent AKI must challenge the notion that a single normal point of contact serum creatinine value substantially reduces the likelihood of its occurrence.
-
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.
-
Curr Opin Anaesthesiol · Feb 2017
ReviewSleep, sleep studies and sleep-disordered breathing: basic knowledge for the anesthesiologist.
To provide a basic understanding of sleep physiology, the pathophysiology of sleep-disordered breathing and the processes applied in undertaking and assessing sleep studies. ⋯ This review describes the physiology of sleep including sleep stages, sleep monitoring, the normal hypnogram and investigation from simple overnight pulse oximetry to full polysomnography. The pathophysiology of sleep-disordered breathing is discussed; from simple snoring through obstructive sleep apnoea to obesity hypoventilation syndrome. The relationship to metabolic syndrome is explored.Salient points in the interpretation of sleep study reports are presented.
-
Curr Opin Anaesthesiol · Feb 2017
ReviewTherapy of acute kidney injury in the perioperative setting.
The current review analyzes the current pharmacologic approaches in cardiac surgery-associated acute kidney injury and renal replacement/support therapies. ⋯ Cardiac surgery is responsible for the highest risk of renal dysfunction with respect to other surgical settings. A number of different and coacting insults, including toxins, renal hypoperfusion, ischemia-reperfusion injury, and systemic inflammation, are leading causes of this frequent complication. Intense research is ongoing on the treatment of established cardiac surgery-associated acute kidney injury and, in this view, a holistic approach including preoperative data, risk stratification, prevention, timely diagnosis, and aggressive intervention can limit the burdening consequences of renal dysfunction in these patients. Although no specific pharmacologic and nonpharmacologic strategy can be currently recommended outside clinical research, the prompt identification of renal dysfunction and the application of multimodal treatments are fundamental aspects. Right ventricular dysfunction and increased central venous pressure, frequently affecting cardiac surgery patients, potentially lead to congestive renal dysfunction. Hemodynamic management covers a central role in these cases.
-
Curr Opin Anaesthesiol · Feb 2017
ReviewSingle-lung ventilation and oxidative stress: a different perspective on a common practice.
To summarize what is currently known about the relationship between single-lung ventilation (SLV), oxidative stress, and postoperative disruption of organ function. ⋯ SLV and subsequent re-expansion of atelectatic lung are associated with the generation of reactive oxygen and nitrogen species that may modulate persistent systemic effects.