Masui. The Japanese journal of anesthesiology
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Chronic kidney disease (CKD), defined by abnormalities in kidney function or damage stable for more than three months, is a relatively common disease in Japan. A high prevalence of pain-associated disease is reported in the CKD population. ⋯ Furthermore, certain analgesics can increase the risk of acute kidney injury and they should be avoided in CKD patients. The aim of this article is to review the considerations needed for pain management in CKD patients.
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Review
[Perioperative management after non-cardiac surgery in patients with chronic kidney disease].
The number of patients with chronic kidney disease (CKD) continues to increase all over the world for the past ten years. It follows that we have more CKD patients with various complications who need perioperative management in Japan. ⋯ Safe comprehensive anesthetic management is required in order not to aggravate the preoperative CKD. In this review, we will take up some recent topics and novel concept in association with noncardiac surgery for the perioperative management of CKD patients.
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The concept and the definition of CKD proposed by The National Kidney Foundation (USA) have been there for 10 years. The Japanese Society of Nephrology also has conducted the education and the spread of CKD. Consequently, in 2009 the newly introduced dialysis patients reached the ceiling in number in Japan. Definition, diagnosis, grading and the treatment of CKD published in 2012 by The Japanese Society of Nephrology were reviewed in this article.
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Case Reports
[Anesthetic management of emergency cesarean section in a patient with acquired von Willebrand syndrome].
Acquired von Willebrand syndrome (AvWS) is generic name of bleeding disorders caused by acquired decrease of von Willebrand factor. A 25-year-old woman with AvWS underwent emergent cesarean section under combined spinal and epidural anesthesia. Before operation, her APTT was within normal ranges. ⋯ Epidural catheter was removed just after administration of factor VIII concentrate 3 days after operation. The perioperative course was uneventful and the patient was discharged 11 days after the operation. It is important to co-operate with other related departments in managing the perioperative coagulation status in a patient with AvWS.
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Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. ⋯ Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.