Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Nash, Danielle M.; Mustafa, Reem A.; McArthur, Eric; Wijeysundera, Duminda N.; Paterson, J. Michael; Sharan, Sumit; Vinden, Christopher; Wald, Ron; Welk, Blayne; Sessler, Daniel I.; Devereaux, P. J.; Walsh, Michael; Garg, Amit X.

doi:10.1007/s12630-015-0315-1

Cited by 27 publications

(16 citation statements)

References 26 publications

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“…66 A recent populationbased historical cohort study found combined general and neuraxial anaesthesia to have a similar incidence of AKI when compared with general anaesthesia alone. 67…”

Section: Anaesthesiamentioning

confidence: 99%

Perioperative acute kidney injury

Goren

Matot

2015

British Journal of Anaesthesia

198

157

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Perioperative acute kidney injury (AKI) is not uncommon and is associated with considerable morbidity and mortality. Recently, several definition systems for AKI were proposed, incorporating both small changes of serum creatinine and urinary output reduction as diagnostic criteria. Novel biomarkers are under investigation as fast and accurate predictors of AKI. Several special considerations regarding the risk of AKI are of note in the surgical patient. Co-morbidities are important risk factors for AKI. The surgery in itself, especially emergency and major surgery in the critically ill, is associated with a high incidence of AKI. Certain types of surgeries, such as cardiac and transplantation surgeries, require special attention because they carry higher risk of AKI. Nephrotoxic drugs, contrast dye, and diuretics are commonly used in the perioperative period and are responsible for a significant amount of in-hospital AKI. Before surgery, the anaesthetist is required to identify patients at risk of AKI, optimize anaemia, and treat hypovolaemia. During surgery, normovolaemia is of utmost importance. Additionally, the surgical and anaesthesia team is advised to use measures to reduce blood loss and avoid unnecessary blood transfusion. Hypotension should be avoided because even short periods of mean arterial pressure<55-60 mm Hg carry a risk of postoperative AKI. Higher blood pressures are probably required for hypertensive patients. Urine output can be reduced significantly during surgery and is unrelated to perioperative renal function. Thus, fluids should not be given in excess for the sole purpose of avoiding or treating oliguria. Use of hydroxyethyl starch needs to be reconsidered. Recent evidence indicates a beneficial effect of administering low-chloride solutions.

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“…66 A recent populationbased historical cohort study found combined general and neuraxial anaesthesia to have a similar incidence of AKI when compared with general anaesthesia alone. 67…”

Section: Anaesthesiamentioning

confidence: 99%

Perioperative acute kidney injury

Goren

Matot

2015

British Journal of Anaesthesia

198

157

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“…Previous work suggests that neuraxial anesthesia is not protective for cardiovascular outcomes. 23 None of the defined secondary outcomes of POISE-2 differed significantly between groups at 1 yr. The tertiary outcome of congestive heart failure was increased at the 1-yr follow-up in patients randomized to clonidine (hazard ratio = 1.54; 95% CI, 1.10 to 2.15, P = 0.012).…”

Section: Perioperative Medicinementioning

confidence: 86%

One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery

et al. 2020

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Background The authors previously reported that perioperative aspirin and/or clonidine does not prevent a composite of death or myocardial infarction 30 days after noncardiac surgery. Moreover, aspirin increased the risk of major bleeding and clonidine caused hypotension and bradycardia. Whether these complications produce harm at 1 yr remains unknown. Methods The authors randomized 10,010 patients with or at risk of atherosclerosis and scheduled for noncardiac surgery in a 1:1:1:1 ratio to clonidine/aspirin, clonidine/aspirin placebo, clonidine placebo/aspirin, or clonidine placebo/aspirin placebo. Patients started taking aspirin or placebo just before surgery; those not previously taking aspirin continued daily for 30 days, and those taking aspirin previously continued for 7 days. Patients were also randomly assigned to receive clonidine or placebo just before surgery, with the study drug continued for 72 h. Results Neither aspirin nor clonidine had a significant effect on the primary 1-yr outcome, a composite of death or nonfatal myocardial infarction, with a 1-yr hazard ratio for aspirin of 1.00 (95% CI, 0.89 to 1.12; P = 0.948; 586 patients [11.8%] vs. 589 patients [11.8%]) and a hazard ratio for clonidine of 1.07 (95% CI, 0.96 to 1.20; P = 0.218; 608 patients [12.1%] vs. 567 patients [11.3%]), with effect on death or nonfatal infarction. Reduction in death and nonfatal myocardial infarction from aspirin in patients who previously had percutaneous coronary intervention at 30 days persisted at 1 yr. Specifically, the hazard ratio was 0.58 (95% CI, 0.35 to 0.95) in those with previous percutaneous coronary intervention and 1.03 (95% CI, 0.91to 1.16) in those without (interaction P = 0.033). There was no significant effect of either drug on death, cardiovascular complications, cancer, or chronic incisional pain at 1 yr (all P > 0.1). Conclusions Neither perioperative aspirin nor clonidine have significant long-term effects after noncardiac surgery. Perioperative aspirin in patients with previous percutaneous coronary intervention showed persistent benefit at 1 yr, a plausible sub-group effect. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…В когортном исследовании, проведенном D. Nash, R. Mustafa, E. McArthur и соавт. [46], было выявлено, что сочетание общей анестезии с нейроаксиальной сопровождается аналогичной по сравнению только с общей анестезией частотой ОПП.…”

Section: интраоперационное ведениеunclassified

Perioperative management of patients with renal insufficiency

Zabolotskikh¹,

Afonchikov²,

Bayalieva³

et al. 2018

Anesteziologiya I Reanimatologiya

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В обзоре представлены современные подходы по ведению пациентов с острым повреждением почек на различных этапах периоперационного периода. Послеоперационное острое повреждение почек является одним из самых серьезных осложнений во время госпитализации и увеличивает заболеваемость, смертность и продолжительность пребывания в стационаре. Частота встречаемости периоперационного острого повреждения почек зависит от характера оперативного вмешательства и колеблется в широком диапазоне-от 0,8 до 94%. В обзоре представлены диагностические критерии и классификация острого повреждения почек согласно рекомендациям Kidney Disease Improving Global Outcomes (KDIGO). Дано этиологическое и патогенетическое обоснование развития различных форм острого повреждения почек. Представлены рекомендации по профилактике и лечению острого повреждения почек на дооперационном, интраоперационном и послеоперационном периоде, сформулированные с позиции доказательной медицины. В частности, даны рекомендации по инфузионной терапии, контролю волемического статуса, гемодинамической и нутритивной поддержке, использованию диуретиков, профилактике контраст-индуцированного повреждения почек и коррекции режима введения нефротоксических препаратов. Обсуждены подходы к началу проведения и режимы заместительной почечной терапии. Ключевые слова: острое повреждение почек, периоперационный период, заместительная почечная терапия.

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Combined general and neuraxial anesthesia versus general anesthesia: a population-based cohort study

Cited by 27 publications

References 26 publications

Perioperative acute kidney injury

Perioperative acute kidney injury

One-year Results of a Factorial Randomized Trial of Aspirin versus Placebo and Clonidine versus Placebo in Patients Having Noncardiac Surgery

Perioperative management of patients with renal insufficiency

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