Impact of the interval between coronary angiography and off-pump coronary bypass surgery on postoperative renal function

BACKGROUND: Postoperative acute kidney injury (AKI) is a significant complication after coronary artery bypass surgery. Prior coronary angiography increases the likelihood of AKI due to the use of a radiocontrast dye. This study examined the effect of coronary angiography on the postoperative renal function after off-pump coronary artery bypass surgery (OPCAB). METHODS: The records of 110 patients who required OPCAB were reviewed. These patients also had at least two of the following conditions: chronic kidney disease, hypertension, diabetes mellitus, emergency surgery, congestive heart failure, age >75 years, hematocrit /=50% or >/=0.3 mg/dl within 48 hours. RESULTS: The postoperative changes in the SCr, cystatin C and eGFR were similar in the two groups. The incidence of AKI and renal replacement therapy were similar in the two groups. CONCLUSIONS: Coronary angiography performed within two days of OPCAB does not affect the postoperative renal functionope

Prevention of acute kidney injury and protection of renal function in the intensive care unit

Acute renal failure on the intensive care unit is associated with significant mortality and morbidity. To determine recommendations for the prevention of acute kidney injury (AKI), focusing on the role of potential preventative maneuvers including volume expansion, diuretics, use of inotropes, vasopressors/vasodilators, hormonal interventions, nutrition, and extracorporeal techniques. A systematic search of the literature was performed for studies using these potential protective agents in adult patients at risk for acute renal failure/kidney injury between 1966 and 2009. The following clinical conditions were considered: major surgery, critical illness, sepsis, shock, and use of potentially nephrotoxic drugs and radiocontrast media. Where possible the following endpoints were extracted: creatinine clearance, glomerular filtration rate, increase in serum creatinine, urine output, and markers of tubular injury. Clinical endpoints included the need for renal replacement therapy, length of stay, and mortality. Studies are graded according to the international Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) group system Several measures are recommended, though none carries grade 1A. We recommend prompt resuscitation of the circulation with special attention to providing adequate hydration whilst avoiding high-molecular-weight hydroxy-ethyl starch (HES) preparations, maintaining adequate blood pressure using vasopressors in vasodilatory shock. We suggest using vasopressors in vasodilatory hypotension, specific vasodilators under strict hemodynamic control, sodium bicarbonate for emergency procedures administering contrast media, and periprocedural hemofiltration in severe chronic renal insufficiency undergoing coronary intervention

Evaluation clinique d'un nouveau test diagnostique d'allergie aux curares (le basotest)

MONTPELLIER-BU Médecine (341722104) / SudocMONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt des dosages de troponine Ic en périopératoire de chirurgie vasculaire chez les patients ayant une coronaropathie ou à haut risque coronaire

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Régulation hormonale de la pression artérielle sous anesthésie (étude du système rénine-angiotensine)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUP (751062107) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Remifentanil in the intensive care unit: tolerance and acute withdrawal syndrome after prolonged

SEDATION in the intensive care unit should be minimized to reduce the duration of mechanical ventilation and its related complications.1 The drug regimen would ideally allow rapid awakening, to perform neurologic and respiratory evaluation on a daily basis.2,3 In this context, remifentanil, with its unique pharmacokinetic profile, should be considered an agent of choice.4,5 However, acute tolerance and even hyperalgesic response have been observed after opioid administration.6-8 In addition, withdrawal syndrome after cessation of opioid-based sedation has been seen in the intensive care unit setting.9-11 We report three cases of severe and fast-onset withdrawal syndrome, with signs of acute tolerance, after remifentanil-based sedation of between 2 and 30 days' duration, requiring reintroduction of remifentanil and then tapering over 24-48