Perioperative Aspirin and Clonidine and Risk of Acute Kidney Injury

Garg, Amit X.; Kurz, Andrea; Sessler, Daniel I.; Cuerden, Meaghan; Robinson, Andrea; Mrkobrada, Marko; Parikh, Chirag R.; Mizera, Richard; Jones, Philip M.; Tiboni, Maria; Font, A. E. Gonzalez; Cegarra, V.; Gomez, Maria Fernanda Rojas; Meyhoff, Christian S.; VanHelder, Tomas; Chan, Matthew T.V.; Torres, David; Parlow, Joel L.; Nadal, Miriam de; Amir, Mohammad; Bidgoli, Seyed Javad; Pasin, Laura; Martinsen, Kristian R; Málaga, Germán; Myles, Paul S.; Acedillo, Rey; Roshanov, Pavel S; Walsh, Michael; Dresser, George K.; Kumar, Priya A.; Fleischmann, Edith; Villar, Juan Carlos; Painter, Thomas; Biccard, Bruce; Bergese, Sergio D.; Srinathan, Sadeesh; Cata, Juan P.; Chan, Vincent; Mehra, Bhupendra; Wijeysundera, Duminda N.; Leslie, Kate; Forget, Patrice; Whitlock, Richard; Yusuf, Salim; Devereaux, P. J.

doi:10.1001/jama.2014.15284

Cited by 113 publications

(87 citation statements)

References 41 publications

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“…Recently in a randomized controlled trial remote ischemic preconditioning was found to be protective against contrast medium induced AKI for patients undergoing elective coronary angiography and who were judged to be at high risk for AKI[134]. Similar results were found in a randomized controlled trial of 120 patients undergoing elective cardiac surgery, in which the patients randomized to RIPC had significantly less risk of postoperative AKI [130]. While these early trials provide the promise of a novel, noninvasive and virtually morbidity-free therapy to prevent AKI, further investigation is needed to define the indications and utility of this approach.…”

Section: Prevention and Treatment Of Perioperative Akimentioning

confidence: 60%

“…In contrast the use of sodium bicarbonate prolonged the duration of mechanical ventilation and ICU length of stay, and increased the risk of alkalemia [129]. A recent large randomized clinical trial of patients undergoing noncardiac surgery found that neither aspirin nor clonidine administered perioperatively reduced the risk of AKI (13.4% for aspirin vs 12.3% for placebo; 13.0% for clonidine vs 12.7% for placebo), whereas both aspirin and clonidine were associated with clinically important adverse effects [130]. …”

Section: Prevention and Treatment Of Perioperative Akimentioning

confidence: 99%

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Acute Kidney Injury in the Surgical Patient

Hobson

Singhania

Bïhorac

2015

Critical Care Clinics

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Synopsis Perioperative acute kidney injury (AKI) is a common, morbid and costly surgical complication. Current efforts to understand and manage AKI in surgical patients focus on prevention, mitigation of further injury when AKI has occurred, treatment of associated conditions and facilitation of renal recovery. Lesser severity AKI is now understood to be much more common, and more morbid, than was previously believed. The ability to detect AKI within hours of onset would be helpful in protecting the kidney and in preserving renal function, and several imaging and biomarker modalities are currently being evaluated. Automated, rapid and noninvasive collection and analysis of preoperative and operating room data raises the prospect of real time risk prediction for perioperative AKI. Prevention of AKI is of paramount importance, and goal-directed fluid management, remote ischemic preconditioning and early involvement of a nephrologist have all been shown to be effective.

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Section: Prevention and Treatment Of Perioperative Akimentioning

confidence: 60%

Section: Prevention and Treatment Of Perioperative Akimentioning

confidence: 99%

Acute Kidney Injury in the Surgical Patient

Hobson

Singhania

Bïhorac

2015

Critical Care Clinics

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“…In summary, both dexmedetomidine and clonidine when administered perioperatively can reduce morphine consumption up to 24 h and to a similar extent as acetaminophen (paracetamol), but not as much as other NSAIDs. Both clonidine and dexmedetomidine have other side effects such as sedation and hypotension that have to be considered (Garg et al 2014). Typical doses of clonidine range from 1 to 5 mcg/kg PO, IV, or perineurally and for dexmedetomidine from 0.5 mcg/kg IV bolus followed by an infusion of 0.2–0.7 mcg/kg/h or 0.5 mcg/kg perineurally.…”

Section: Resultsmentioning

confidence: 99%

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1—from the preoperative period to PACU

et al. 2017

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BackgroundWithin an enhanced recovery pathway (ERP), the approach to treating pain should be multifaceted and the goal should be to deliver “optimal analgesia,” which we define in this paper as a technique that optimizes patient comfort and facilitates functional recovery with the fewest medication side effects.MethodsWith input from a multi-disciplinary, international group of clinicians, and through a structured review of the literature and use of a modified Delphi method, we achieved consensus surrounding the topic of optimal analgesia in the perioperative period for colorectal surgery patients.DiscussionAs a part of the first Perioperative Quality Improvement (POQI) workgroup meeting, we sought to develop a consensus document describing a comprehensive, yet rational and practical, approach for developing an evidence-based plan for achieving optimal analgesia, specifically for a colorectal surgery ERP. The goal was two-fold: (a) that application of this process would lead to improved patient outcomes and (b) that investigation of the questions raised would identify knowledge gaps to aid the direction for research into analgesia within ERPs in the years to come. This document details the evidence for a wide range of analgesic components, with particular focus from the preoperative period to the post-anesthesia care unit. The overall conclusion is that the combination of analgesic techniques employed in the perioperative period is not important as long as it is effective in delivering the goal of optimal analgesia as set forth in this document.

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“…Several studies have investigated the mortality and post-operative complications in a wide variety of surgical populations, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] but in the majority of studies, observation time is short and appears to vary between in-hospital, 30-day, and 90-day mortality.…”

Section: Editorial Commentmentioning

confidence: 99%