Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (> 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72 h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

Anesthesia management in pediatric patients undergoing percutaneous closure of atrial and ventricular septal defects in catheter laboratory: Retrospective clinical study

Along with technological and medical advances, diagnostic and therapeutic cardiac catheterization commonly used in pediatric patients; it is frequently preferred the percutaneous closure of ASD/VSD. In this study, it was aimed to evaluate anesthesia management of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory. This was a retrospective review of pediatric patients undergoing percutaneous closure of ASD/VSD in catheter laboratory between 20122017. Demographic and clinical characteristics were recorded, and all results of anesthesia management were evaluated. Thirty-eight patients (18 males, 20 females) with a mean age of 7,71 ± 3,57 years underwent percutaneous closure of ASD/VSD. Of the cases; 78,4% diagnosed ASD, 21,6% diagnosed VSD were operated. The most common presenting symptoms were murmur (55,3%), chest pain (21,1%) and palpitation (10,5%), Mean defect size was 11.60 ± 6.27 mm for ASD and 6.00 ± 4.64 mm for VSD. Mean anesthesia time was 71.33 ± 22.77 minutes for ASD and 85.83 ± 26.91 minutes for VSD. Mean procedure time was 56.00 ± 20.56 minutes for ASD and 69.16 ± 28.70 minutes for VSD. Premedication was performed for 94,7%, anesthesia induction was performed with propofol (94,7%), fentanyl (63,2%), rocuronium (65,8%). Sevoflurane was used for anesthesia maintenance. TEE was used in 86,8% of the cases. Complications developed for 3 cases. IV paracetamol was preferred in 84,2%. Anesthetist must consider carefully premedication, anesthetic agent preferences, general anesthesia or sedation, complications by catheterization, discomforts of transesophageal echocardiography, hemodynamic instability, requirement of immobility and adequate analgesia. [Med-Science 2018; 7(3.000): 486-490

Anesthetic management in a patient with Friedreichs Ataxia: a different approach

Friedreich's Ataxia (FA) is a rare autosomal recessive disease. FA is clinically characterized by progressive ataxia, especially loss of reflex and power in the lower extremities, spasticity and loss of proprioceptive sensory. There is an increased sensitivity to non-depolarizing muscle relaxants in neurodegenerative diseases. Care must be taken of anesthesia management for the use of volatile anesthetics and muscle relaxants, and precautions should be taken for difficult airway management which is due to secondary to kyphoscoliosis and comorbidities. In this case, anesthesia management of emergency operation for septal hematoma by TIVA without using of muscle relaxants and minimalized hemodynamic response depending on the intubation by videolaryngoscope were presented. [Med-Science 2017; 6(1.000): 109-10

General anesthesia management in 15 preterm infant undergoing diode laser photocoagulation for retinopathy of prematurity: a retrospective study

Anesthesia management of preterm infants is challenging for the anesthesiologist. Because of the rudimentary build of the infants, many medical and physical problems have been observed in the treatment of the disease such as complications, airway problems, temperature disregulation and deficient drug metabolism. This retrospective study evaluates the perioperative management and postoperative course in premature infants undergoing diode laser photocoagulation (DLP) for retinopathy of prematurity (ROP). We analyzed the preoperative data, anesthesia chart, and postoperative course of 15 preterm infants for general anesthesia exposures for ROP surgery. Minimum weight and gestational age at birth were 480 g and 23 weeks, respectively. Mean value of weight at birth was less than 1000 g (886,3g) differently from other studies. The mean anesthesia and surgery duration were 80,9 and 60,4 min, respectively. Paracetamol was implemented for postoperative analgesia through rectal route in 5 infants and intravenous route in 10 infants at the start of surgery. Eleven patients were extubated in the operating room and 4 infants were extubated in the following days. Birth weights of infants were between 480 and 1240 g. Supraglottic airway such as I-gel was applied in 5 infants, laryngeal mask airway (LMA) in 5 infants and endotracheal intubation (ETI) was applied in 4 infants. In the present study, we found that intraoperative complications, duration of anesthesia and surgery were acceptable and similar to those of other studies. However, the value of apnea in current study was less significant when compared to other studies,which can be correlated with intubation without muscle relaxant or post-conceptual age over 35 weeks. [Med-Science 2018; 7(1.000): 65-68

Ultrasound-guided erector spinae plane block for postoperative analgesia in patients undergoing various types of surgery

Ultrasound-guided erector spinae plane (ESP) block is regional anesthesia technique for the management of thoracic and abdominal neuropathic pain. ESP block may also be a good option to provide postoperative analgesia. In this case report, we describe our experiences of ESP block used for postoperative analgesia in three patients undergoing laparoscopic-assisted percutaneous nephrolithotomy (PCNL), laparoscopic-assisted total abdominal hysterectomy (TAH), and a unilateral total mastectomy. In all three patients, ESP block provided effective analgesia and increased patient satisfaction according to their pain management scores (numerical rating scale [NRS]). [Med-Science 2022; 11(1.000): 403-6

The effects of endotracheal intubation via McGRATH Videolaryngoscope on intraocular pressure: A randomized clinical trial

In this study; we aimed to compare the effects of endotracheal intubation via direct laryngoscope and McGRATH videolaryngoscope (VL) on intraocular pressure. Total of 50 ASA (American Society of Anesthesiologist) Grade 1-2, Mallampati score 1 or 2, age between 18 to 65 patients planned to undergo nonophthalmic surgery were included to study. Patients were divided randomly into 2 groups as direct laryngoscopic (Macintosh)(n=25) and videolaryngoscopic (McGRATH)(n=25) intubation group. The mean arterial blood pressure (MAP) and heart rate (HR) recorded by anesthesiologist and intraocular pressure (IOP) measured by ophthalmologist with tonopen device were recorded pre-induction (basal), pre-intubation, 1th,3rd,5th minutes of intubation, respectively. Study terminated after 5th minute values taken. There were no statistically significant differences in distirubiton of sex, weight, age, height, and ASA between groups. Duration of intubation in McGRATH group was 32 ± 2 s and statistically significantly longer than Macintosh group (23.8 ± 2.9 s)(p [Med-Science 2018; 7(2.000): 364-8