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. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07169-7.

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The costoclavicular approach to the brachial plexus block has been recently described as a technique for anesthesia or postoperative analgesia of distal upper limb. In this article, we describe a case in which a continuous costoclavicular brachial plexus block was performed in a pediatric patient for conservative treatment of a traumatic radial fracture with severe elbow rigidity. Perineural catheter placement is a valuable option for pain control and functional prognosis during rehabilitation.

Epidural catheter placement is one of the most effective, secure, and worldwide used pain control modalities. Epidural catheter dislodgment is a common cause of epidural block failure. The diagnosis of this situation is usually presumptive, and cases in which the actual trajectory and final location of the catheter are witnessed by imaging are rare.We present two cases of the insufficient epidural block due to catheter migration, confirmed by a CT scan with radiopaque contrast injection through the catheter. In the first case, the catheter tip was identified in the left major psoas muscle. Some catheter holes were probably located in a border zone between two compartments, which made the analgesic efficacy dependent on the infusion rate. In the second case, the catheter tip was identified as lodged in the left paravertebral space, which explains only unilateral left pain relief.In selected situations, like repeated ineffectiveness and in pretended long-duration catheters, imaging tests may be useful to determine the actual position of the catheter and identify anatomical variations that may lead to an incorrect replacement.

Anaphylaxis is a rare but devastating occurrence during the perioperative period. Its incidence is estimated to be 1 in 3 500 to 1 in 20 000 surgeries, with a mortality rate currently in the range of 0-1.4% and an unknown morbidity rate [1;3]. Considering that in induction and maintenance of anaesthesia, multiple drugs are administered in a sequential manner and in short periods of time, there is a higher risk of coming across these severe imune-mediated reactions.