EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Biomarkers in traumatic brain injury [Travmatik beyin hasarinda biyobelirteçler]

Traumatic brain injury is defined as the impairment of thebrain function due to physical force to the head. Functional, cellular and molecular changes occur. The resulting heterogeneous outcome makes it difficult to assess the clinical status and predict the prognosis. Traumatic brain injury may lead to an asymptomatic clinic following a mild injury, or may lead to a progression to death in moderate or severe injuries. In this review, we aimed to reveal the biomarkers in brain damage for diagnosis, prognosis and treatment planning. © 2018 Anestezi Dergisi. All rights reserved

Anesthetic approach of vagal nerve stimulation: Retrospective case series study

Objective: Vagal nerve stimulation is an alternative treatment method for epileptic patients who are resistant to medical treatment. In this retrospective case series, we investigated our anesthetic approach and possible complications in patients implanted vagal nerve stimulator (VNS). Method: In this study, the results of 10 patients, who were implanted VNS between January 2015 and December 2016, were examined. Cases were ASA I-II adult patients between 19-35 years of age. Intraoperative arrhythmia or asystole and possible postoperative complications such as aspiration, hypoxia, vocal cord paralysis were noted. Results: Intraoperative bradycardia improved by interruption of surgical stimulation was observed only in one patient, no bradycardia or asystole was observed in others. At the end of 3 months follow-up a 30-75% reduction in seizure frequency was identified. Postoperative Horner syndrome, peritracheal hematoma, vocal cord paralysis, aspiration were not observed, but in two cases pharynx pain was detected in early postoperative period. Conclusion: Implantation of VNS requires general anesthesia and endotracheal intubation. Large diameter iv catheter is safe because of the proximity of vagal nerve to internal carotid artery and jugular vein. Close hemodynamic monitoring and follow-up is essential because of possibility of arrhythmia, bradyarrhythmia, and asystole during VNS placement. © 2018 Anestezi Dergisi. All rights reserved

Anesthetic management of laryngectomy and neck dissection surgery: Retrospective analysis [Larenjektomi ve boyun diseksiyonu operasyonlarinda anestezi yönetimi: Retrospektif analiz]

Objective: Laryngectomy and neck dissection are among the special operations in terms of anesthesia management as well as surgical application. In this retrospective study, it was aimed to evaluate the perioperative anesthesia management of the patients who underwent laryngectomy and/or neck dissection operation by the otolaryngology department and discuss. Method: A total of 44 patients between 2014 and 2017 were retrospectively evaluated. Results: The study was completed with 42 patients as all records of 2 could'nt obtained. Forty patients were male and 2 were female. Total laryngectomy+neck dissection was performed in 31 patients(73.8%), total laryngectomy+total thyroidectomy+neck dissection operation was performed in 11 patients (26.2%). Mean blood loss was 239±156 ml. No blood and blood products were transfused for 35 patients (83.3%). Four patients had 1 unit and 3 patients had 2 erythrocyte suspension units. The most common complication observed during the operation was deep hypotension with 23.8% (10 patients). Ephedrine and adrenaline were applied in the treatment of hypotension. Three patients required deep bradycardia for treatment and atropine was administered. Hypocalcemia developed in 12 patients, postoperatively. Conclusion: Laryngectomy and neck dissection operations are special operations in terms of surgery and anesthesia management and require close follow-up for possible peroperative and/or postoperative complications. © 2018 Anestezi Dergisi. All rights reserved

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369.