Hypotensive anesthesia with propofol and remifentanil: protective effect of alpha-tocopherol on renal function

Lubrano, Riccardo; Marandola, Marzia; Antonucci, Andrea; Tellan, Guglielmo; Elli, Marco; Santulli, Maria; Lauria, D; Guido, Giuliana; Delogu, Giovanna

doi:10.1016/j.jclinane.2007.09.015

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…The authors showed transient increase more than the normal ranges in ALT and γ-glutamyltranspeptidase following TIVA with midazolam and fentanyl whereas BUN and creatinine remained in the normal limits. In the study by Lubrano et al, hypotensive anesthesia with propofol and remifentanil produced transient nephrotubular dysfunction in patients without renal disease [24].…”

Section: Discussionmentioning

confidence: 98%

Postoperative Liver and Kidney Function Following Total Intravenous Anesthesia: A Randomized Controlled Trial

Parsa¹

2018

Austin J Anesthesia and Analgesia

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Section: Discussionmentioning

confidence: 98%

Postoperative Liver and Kidney Function Following Total Intravenous Anesthesia: A Randomized Controlled Trial

Parsa¹

2018

Austin J Anesthesia and Analgesia

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“…Studies also show that hypotensive epidural anesthesia can be safely used in higher risk patients, including the elderly, and patients with hypertension, ischemic heart disease, or chronic renal impairment [7,17]. Lubrano et al [11] demonstrated a transient tubular dysfunction after induced hypotension with propofol and remifentanil (without concurrent adrenaline); however, a clear link to permanent renal dysfunction has not been demonstrated [17]. Specific concerns regarding spinal cord ischemia caused by prolonged periods of hypotension with neuraxial anesthetics is also well documented; studies have demonstrated a MAP of at least 60 mmHg is required to safely maintain spinal cord blood flow [14].…”

Section: Discussionmentioning

confidence: 99%

“…Tachycardia from intraoperative hypovolemia maybe masked with the technique and careful monitoring of blood loss during surgery is crucial. Despite these risks, studies have shown no increased incidence of end-organ damage after hypotensive epidural anesthesia, even in patients with existing comorbidities [7,11,17].…”

Section: Introductionmentioning

confidence: 99%

Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

Freeman

Thorne

Gaston

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Resection of pelvic and sacral tumors can cause severe blood loss, complications, and even postoperative death. Hypotensive epidural anesthesia has been used to mitigate blood loss after elective arthroplasty, but to our knowledge, it has not been studied as an approach that might make resection of pelvic and sacral tumors safer. Questions/purposes The purposes of this study were (1) to compare the blood loss and blood product use for patients undergoing pelvic and sacral tumor surgery under standard anesthesia or hypotensive epidural anesthesia; (2) to assess the frequency of end-organ damage with the two techniques; and (3) to compare 90-day mortality between the two techniques. Methods Between 2000 and 2014, 285 major pelvic and sacral resections were performed at one center. A total of 174 (61%) had complete data sets for analysis of blood loss, transfusion use, complications, and mortality at 90 days. Of those, 102 (59%) underwent hypotensive epidural anesthesia, whereas the remainder received standard anesthetic care. The anesthetic approach was determined by the anesthetists in charge of the case with hypotensive epidural anesthesia exclusively performed by one of two subspecialty trained anesthetists as their routine for major pelvic or sacral surgery. The groups were comparable in terms of potential confounding variables such as age, gender, tumor volume, and operation performed. Hypotensive epidural anesthesia was defined as a technique using an extensive epidural block up to T2-3 dermatome, peripherally administered low-concentration intravenous adrenaline infusion, and using unimpeded spontaneous respiration to achieve controlled hypotension, precise rate control of the heart, and enhanced velocity of venous return, all aggregated thus to minimize blood loss during pelvic surgery while preserving vital perfusion. The groups were assessed for perioperative blood loss calculated from pre-and postsurgery hemoglobin and transfusion use as well as postoperative complications, morbidity, and mortality at 90 days. Results There was less mean blood loss in the hypotensive epidural anesthesia group (1457 mL, SD 1721, 95% confidence interval [CI], 1114-1801 versus 2421 mL, SD 2297, 95% CI, 1877-2965; p = 0.003). Patients in the hypotensive epidural anesthesia group on average received fewer packed red cell transfusions (2.7 units, SD 2.9, 95% CI, 2.1-3.2 versus 3.9 units, SD 4.4, 95% CI, 2.9-5.0; Each author certifies that he, or a member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all in...

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“…According to its unique pharmacokinetic profile, remifentanil-based anesthesia combines high dose opioid intraoperative analgesia with a rapid and predictable postoperative awakening, which is independent of the duration of the infusion. When used for hypotensive anesthesia, each of these three drugs is equally effective in achieving hypotensive anesthesia for the required duration [33–35]. Since the recovery times from this type of anesthesia are also short, they are widely used for hypotensive anesthesia.…”

Section: Protocols For Hypotensive Anesthesiamentioning

confidence: 99%

“…Reduced blood pressure during surgery may result in transient tubular dysfunction in patients with normal preoperative renal function [35], and the use of hypotensive anesthesia may exacerbate renal function in patients with a known preoperative kidney disease. It is important to remember that the renal functions are affected mainly by the cardiac output and the blood flow in the splanchnic circulation and not by systemic arterial pressure.…”

Section: Patient Selection For Hypotensive Anesthesiamentioning

confidence: 99%

Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

Barák

Leiser

El-Naaj

2015

The Scientific World Journal

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Steady blood pressure within normal limits during surgery is one of the markers of the ideal and skillful anesthesia. Yet, reduced blood pressure is advantageous in some settings because it can contribute to a reduction in overall blood loss and improve the surgical field conditions. Controlled hypotension during anesthesia or hypotensive anesthesia is often used in major maxillofacial operations. Since hypotensive anesthesia carries the risk of hypoperfusion to important organs and tissues, mainly the brain, heart, and kidneys, it cannot be applied safely in all patients. In this paper we review the medical literature regarding hypotensive anesthesia during major maxillofacial surgery, the means to achieve it, and the risks and benefits of this technique, in comparison to normotensive anesthesia.

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Hypotensive anesthesia with propofol and remifentanil: protective effect of alpha-tocopherol on renal function

Cited by 7 publications

References 22 publications

Postoperative Liver and Kidney Function Following Total Intravenous Anesthesia: A Randomized Controlled Trial

Postoperative Liver and Kidney Function Following Total Intravenous Anesthesia: A Randomized Controlled Trial

Hypotensive Epidural Anesthesia Reduces Blood Loss in Pelvic and Sacral Bone Tumor Resections

Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature

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