Is pulsatile perfusion has significant effects on renal function in patients undergoing cardiac surgery? An observational study

Abstract

Introduction. Radiofrequency (RF) ablation is a well-established alternative treatment for primary and secondary lung tumours (1). It is performed in patients who are deemed unsuitable for, or would prefer not to undergo, surgery (2). At present, there is little data or consensus in the literature describing the anaesthetic management of this high-risk cohort of patients in the immediate perioperative period. Method. We describe a case series from our institution of 100 patients over a period of 5 years (2008-2013) who underwent RF ablation for primary lung malignancy under general anaesthesia. Preoperative lung function tests revealed a mean forced expiratory volume in one second (FEV1) of 1.49 litres (range 0.54-3.29L) and a mean % predicted value of 64% (range 25.3-124.1%). 51 patients (51% total patients) had FEV1 o60% of predicted value and of these, 19 patients (19% total patients) had FEV1 o40% of predicted value. The mean patient age was 72. All patients were intubated with single-lumen endotracheal tubes and had positivepressure ventilation for the duration of the case. Anaesthesia was maintained with a mixture of oxygen, air and sevoflurane. Intraoperative analgesia was opiate based in the form of a remifentanil infusion. Results. Immediate extubation post-procedure was achieved in over 95% of these cases. Post-operative recovery was in a highdependency unit setting for a period of 24-72 hours. Our rate of reintubation for respiratory failure and the subsequent requirement of admission to ICU remained low at less than 5%. Discussion. Poor baseline lung function tests can be associated with postoperative pulmonary complications [3], namely respiratory failure requiring re-intubation and prolonged stay in an intensive care setting. Despite the presence of multiple co-morbidities in this group of patients, our case series demonstrated a low rate of anaesthetic complications in patients undergoing RF ablation for pulmonary malignancy under general anaesthesia.

Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction

“…Milano et al found that patients undergoing pulsatile perfusion CPB during aortic valve replacement had no significant differences in pre vs. postoperative creatine clearance, while a statistically significant difference was observed in patients undergoing normal perfusion ( 122 ). Similar results were found by Natarajan et al ( 124 ). Mohammadzadeh et al found more extensive dysregulation in BUN and creatinine levels in patients undergoing non-pulsatile CPB ( 125 ).…”