SummaryAcute renal failure is a frequent complication of critical illness and optimal preventive therapy remains elusive. There is increasing evidence from animal models and some human studies that adenosine receptor antagonism by aminophylline may reduce the severity of renal impairment caused by a variety of aetiologies. We studied the renal effects of intravenous aminophylline in an unblinded, within-patient study of 20 patients admitted to a general intensive care unit following major surgery. We demonstrated that there were no adverse cardiovascular complications related to aminophylline therapy. Renal sodium and osmolar clearance increased with a non-significant trend towards increased diuresis during treatment. Creatinine clearance, however, was unchanged but the study was not designed and did not have the power to test whether aminophylline increased renal blood flow or glomerular filtration rate. We suggest the renal actions of aminophylline in critical illness merit further investigation. Acute renal failure is a frequent complication of critical illness, major surgery and in particular sepsis. Renal replacement therapy is associated with prolongation of intensive care and increased mortality. Factors that increase the risk of renal impairment include pre-existing renal impairment, insulin-and non-insulin-dependent diabetes, hypertension, atherosclerosis, particularly renal arterial disease, jaundice and increasing age [1].The pathophysiology of acute renal failure is not fully understood and hence optimum therapies for prevention of acute renal failure in patients at risk remain elusive. Animal-based research has suggested that adenosineinduced renal vasoconstriction may have an important role in the pathophysiology of acute renal failure and that adenosine receptor antagonists are protective.In major abdominal surgery and critical illness where ischaemic renal impairment may result, we hypothesised that theophylline, an adenosine A1 and A2 receptor antagonist, may have renal protective action. This was a study to investigate the renal actions of theophylline following major surgery. Methods Study designThe trial was an open, within-patient controlled study of 20 consecutive patients fulfilling the admission criteria. Patients were recruited at The Bristol Royal Infirmary general intensive care unit. The study had local ethics committee approval. Informed consent was obtained if possible, or assent was obtained from a near relative of those patients unable to give consent. Patients and methodsEligible patients were over 18 years of age and had undergone major abdominal surgery requiring admission to the ICU for postoperative management. Patients were haemodynamically stable, defined as in sinus rhythm with a pulse less than 120 beat.min 21 , systolic arterial blood pressure . 100 mmHg without the use of inotropic medication, central venous blood pressure . 8 mmHg and less than 20% variation in these parameters for 3 h before the start of the study. Patients had not received diuretics or dopamine for 6...

Study Objective: Adenotonsillectomy is the recommended treatment for children with obstructive sleep apnea (OSA). Since adenoidectomy alone may be associated with significantly lower morbidity, mortality, and cost, we aimed to investigate whether adenoidectomy alone is a reasonable and appropriate treatment for children with OSA. Methods: Five-hundred fifteen consecutive children diagnosed with moderate-to-severe OSA (apnea-hypopnea index > 5) based on polysomnography and who underwent adenoidectomy or adenotonsillectomy were reevaluated after 17-73 months (mean 41) for residual or recurrent OSA using a validated questionnaire (Pediatric Sleep Questionnaire, PSQ). Failure of OSA resolution was defined as a positive mean PSQ score ≥ 0.33. Contribution of age, obesity, tonsil size, and OSA severity at baseline to adenoidectomy or adenotonsillectomy failure was examined. Results: Positive PSQ score occurred in 15% of the entire sample and was not influenced by age or gender. No difference in failure rate was observed between adenoidectomy and adenotonsillectomy for children who were not obese with apnea-hypopnea index < 10 and had small tonsils (< 3). Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, p = 0.028). Conclusions:We suggest that subjective, long term outcomes of adenoidectomy are comparable to those of adenotonsillectomy in non-obese children under 7 years old with moderately OSA and small tonsils. Hence, adenoidectomy alone is a reasonable option in some children. Future prospective randomized studies are warranted to define children who may benefit from adenoidectomy alone and those children in whom adenoidectomy alone is unlikely to succeed.

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