General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS: Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol) or inhalation anesthesia (sevoflurane). In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum) and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/): RBR-8wt2fy RESULTS: None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION: The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery

Rabdomiólise em pacientes obesos submetidos a derivação gástrica laparotômica e laparoscópica

Submitted by Repositório Arca ([email protected]) on 2019-09-04T17:23:41Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-09-12T12:07:02Z (GMT) No. of bitstreams: 2 Joao Eduardo Marques Tavares de Menezes Ettinger Rabdomiolise...pdf: 52199753 bytes, checksum: e9dcd79a3d6be142ee99e4d635fcf911 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-09-12T12:07:02Z (GMT). No. of bitstreams: 2 Joao Eduardo Marques Tavares de Menezes Ettinger Rabdomiolise...pdf: 52199753 bytes, checksum: e9dcd79a3d6be142ee99e4d635fcf911 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2007Fundação Bahiana para o Desenvolvimento das Ciências. Escola Bahiana de Medicina e Saúde Pública. Salvador, BA, Brasil / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil.A rabdomiólise (RML) é uma síndrome clínica e metabólica causada por lesão e necrose muscular esquelética com liberação de conteúdo intracelular (mioglobina) na circulação sistêmica, podendo sobrecarregar o sistema de filtração renal e causar insuficiência renal aguda (IRA). É causa frequente de necrose tubular aguda e pode ocorrer em cirurgia bariátrica. Os fatores de risco para RML são: tempo cirúrgico prolongado ( > 4h) e IMC elevado. A frequência de RML em cirurgia bariátrica varia de 12,9 por cento a 37,8 por cento na literatura médica. Identificar os fatores de risco para rabdomiólise e IRA é importante para se prevenir estas complicações. Este estudo tem como objetivo avaliar e descrever as características clínicas associadas ao surgimento de RML e IRA em pacientes bariátricos. Foram estudados 114 pacientes obesos submetidos à derivação gástrica (métodos laparoscópico ou aberto) nos Hospitais São Rafael e Cidade, no período de 11 meses, de julho de 2005 a maio de 2006. O tipo de estudo foi uma coorte retrospectiva. O desfecho estudado foi a aquisição de RML associada à IRA. Os critérios para o diagnóstico de RML foram níveis de CK > 950 UI/L ou 5 vezes o normal (190 UI/L), RML grave = CK acima de 4000 UI/L. Os critérios de diagnóstico de IRA foram creatinina ≥ 1,3 mg/dL e elevação da creatinina ≥ 50 por cento dos níveis pré¬operatórios. As variáveis medidas foram IMC, tempo cirúrgico, idade, hidratação e diurese trans¬operatória, CK, creatinina, HAS, doença vascular periférica, diabetes, técnica operatória aberta e laparoscópica. Os dados foram analisados utilizando-se o programa SPSS versão 10.0 para Windows. Critérios de inclusão: pacientes submetidos a derivação gástrica aberta e videolaparoscópica. Exclusão: pacientes com falência renal e pacientes em uso de estatinas. Foi encontrada incidência de 7 por cento de RML, de 59,6 por cento de elevação de CK e de 3,5 por cento de IRA. Os fatores associados na análise bivariada para o desenvolvimento de RML são: esteatose hepática, IMC elevado, peso elevado, excesso de peso, tempo cirúrgico prolongado. O fator de risco na análise multivariada para RML é IMC elevado (IMC ≥ 50kg/m2). O tempo operatório menor levou a uma incidência mais baixa de RML comparado com outros trabalhos, quando a média de tempo foi menor que 3h a incidência de RML ficou abaixo de 10 po cento, e não ocorreu RML grave. Quando o tempo operatório foi menor do que 2h a incidência de RML foi zero. Medidas para diminuir o IMC no pré-operatório e o tempo cirúrgico são fundamentais para atenuar a incidência de RML após cirurgia bariátrica. Os fatores associados na análise bivariada e multivariada para a elevação da CK acima do valor normal são: HAS e técnica operatória aberta. A CK elevada demonstra que pacientes submetidos a cirurgia bariátrica têm uma incidência alta de compressão muscular e uma percentagem destes pacientes irão desenvolver RML, podendo ocorrer também IRA. A incidência de RML e IRA em pacientes submetidos à cirurgia bariátrica é baixa. Medidas para diminuir a elevação dos níveis de CK e o aparecimento de RML ajudam a diminuir a incidência de IRA em cirurgia bariátrica.Rhabdomyolysis (RML) is a metabolic and clinical syndrome caused by muscle injury and necrosis leading to release of intracellular contents (myoglobin) into the systemic circulation, this can cause kidneys overload and lead to acute renal failure (ARF). RML is one frequent cause of acute tubular necrosis and can occur after bariatric surgery. The risk factors for RML are: surgical time longer than 4h and high BML The frequency of RML in bariatric operations varies from 12.9% to 37.8%. Identifing the risk factors for RML and ARF is important to prevent these complications. This study has the objective of evaluate and describe the clinical features associated with RML and ARF in bariatric patients. We studied 114 patients submmited to gastric bypass (laparoscopic and open methods) at the São Rafael Hospital and Cidade Hospital, during 11 months from July 2005 to May 2006. The study was a retrospective Cohort. The studied outcome was the RML acquisition associated to ARF. The diagnostic criteria for RML were CPK level > 950 lU/L i.e. 5 times the normal value (190 lU/L). Severe RML = CPK above 4000 lU/L. The diagnostic criteria for ARF were creatinine > 1.3 mg/dL and elevation of the serum levels of creatinine > 50% of the preoperative levels. The measured variables were BMI, operative time, age, intraoperative hydration and diuresis, CPK, creatinine, arterial hypertension, peripheric vascular disease, diabetes, open and laparoscopic techniques. The data were analized with the SPSS 10.0 software for windows. Inclusion criteria: patients submitted to bariatric surgery (open and laparoscopic gastric bypass). Exclusion: patients with kidney failure and patients using statins. Bariatric surgery leads to a low incidence of complications as RML and ARF. We found a RML incidence of 7%, CPK levels elevation of 59.6% and 3.5% of ARF. The factors associated with the development of RML in the bivariate analysis were: hepatic steatosis, high BMI, high weight, higher excess weight, prolonged surgical time. The risk factor in the multivariate analysis for RML was high BMI (> 50kg/m^). The lower operative time led to a diminished incidence of RML compared to other papers. When the mean operative time was below 3h the incidence of RML stayed below 10% and there was not severe RML. When the operative time was below 2h the incidence of RML was zero. Probably prolonged operative time is associated with a higher risk of RML not statistically demonstrated in this study. Measures to diminish the BMI preoperatively and the operative time are primordial to diminish the incidence of RML after bariatric surgery. The factors associated with CPK levels elevation in the bivariate and multivariate analysis were: hypertension and open technique. The elevated levels of CPK demonstrates that patients submitted to bariatric surgery have a high incidence of muscular compression and a percentage of these patients will develop RML and in some cases ARF also. Measures to diminish the elevation of CPK levels and the development of RML help to diminish the incidence of ARF in bariatric surgery