Best practice & research. Clinical anaesthesiology
-
Best Pract Res Clin Anaesthesiol · Dec 2012
ReviewPerioperative intravascular volume replacement and kidney insufficiency.
Perioperative acute kidney injury (AKI) occurrence is probably increased in recent years due to the increased level of complexity of surgical procedures and severity of illness of surgical patients. Perioperative AKI has a multifactorial aetiology (preoperative co-morbidities such as diabetes, heart failure and chronic kidney disease, emergent surgery, exposure to nephrotoxic drugs, haemodynamic instability, hypothermia, inflammatory response to surgery, hospital-acquired infections and abdominal compartment syndrome). However, fluid choice for perioperative volume replacement might have a major role in perioperative AKI, as administration of crystalloid solutions, colloids or haemoderivates has the potential for kidney injury. This review focusses on the issue of fluid replacement quality and quantity and their association with renal dysfunction.
-
Best Pract Res Clin Anaesthesiol · Dec 2012
ReviewCharacteristics of fluids used for intravascular volume replacement.
In this review, the relative merits of the different fluid solutions used for fluid replacement will be discussed. Differences in chemical composition may have important implications on volume expansion capacities but also on organ function. Among crystalloids, differences in electrolyte composition, and in particular chloride load, alter acid base status but may also affect other aspects of organ function. ⋯ When colloids are indicated, albumin should be preferred as it is the only one that has been proved to be safe in a large randomized trial. Cumulative evidence suggests that starches, even of the new generations, are associated with development of acute kidney injury. Hypertonic solutions may represent an interesting option in some groups of patients but more research is needed in this field.