Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Leite, Tacyano Tavares; Macedo, Etienne; Martins, Izanio da Silva; Neves, Fernanda Macedo de Oliveira; Libório, Alexandre Braga

doi:10.2215/cjn.02330315

Cited by 29 publications

(19 citation statements)

References 21 publications

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“…In another study, patients treated with propofol had better ICU survival than those treated with benzodiazepine. The outcomes for patients in the ICU that were exclusively treated with propofol or midazolam were compared for the first 48 h. Patients treated with propofol had a lower risk of AKI, fluid-related complications, and less need for RRT compared with midazolam [62]. …”

Section: General Anesthesiamentioning

confidence: 99%

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

et al. 2017

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Background: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence. Summary: The effects of anesthetic drugs on renal failure are particularly important in the context of kidney transplantation, since the conditions of preservation following removal profoundly influence the recovery of organ function. Currently, preservation procedures are typically based on the usage of a cold-storage solution. Some anesthetic drugs induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. A more thorough understanding of anesthetic effects on renal function can present a novel approach for developing organ-protective strategies. The aim of this review is to discuss the effects of different anesthetic drugs on renal function, with particular focus on IR injury. Many studies have demonstrated the organ-protective effects of some anesthetic drugs, specifically propofol, which indicate the potential of some anesthetics to introduce novel organ protective targets. This is not surprising, since lipid emulsions are major components of propofol, which accumulating data show provide organ protective effects against IR injury. Key Messages: Thorough understanding of the interaction between anesthetic drugs and renal function remains fundamental to the delivery of safe perioperative care and to optimizing outcomes after renal surgeries, particularly transplant procedures. Anesthetics can be repurposed for organ protection with more information about their effects, especially during transplant procedures. Here, we review the effects of different anesthetic drugs – specifically those that contain lipids in their structure, with special reference to IR injury.

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Section: General Anesthesiamentioning

confidence: 99%

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

et al. 2017

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“…This analysis might be enhanced by somehow incorporating predictors from the current hospitalization. We re-emphasize that no causal inference can be performed in this study, but interesting findings include tacrolimus (known nephrotoxicity [76]), midazolam (this association has been shown relative to propofol [77]), and oxycodone (opioid nephrotoxicity is currently researched [78]). It is worth highlighting the counter-intuitive finding that ibuprofen administration in prior hospitalizations is a negative predictor for AKI.…”

Section: Plosmentioning

confidence: 88%

Predicting acute kidney injury at hospital re-entry using high-dimensional electronic health record data

et al. 2018

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Acute Kidney Injury (AKI), a sudden decline in kidney function, is associated with increased mortality, morbidity, length of stay, and hospital cost. Since AKI is sometimes preventable, there is great interest in prediction. Most existing studies consider all patients and therefore restrict to features available in the first hours of hospitalization. Here, the focus is instead on rehospitalized patients, a cohort in which rich longitudinal features from prior hospitalizations can be analyzed. Our objective is to provide a risk score directly at hospital re-entry. Gradient boosting, penalized logistic regression (with and without stability selection), and a recurrent neural network are trained on two years of adult inpatient EHR data (3,387 attributes for 34,505 patients who generated 90,013 training samples with 5,618 cases and 84,395 controls). Predictions are internally evaluated with 50 iterations of 5-fold grouped cross-validation with special emphasis on calibration, an analysis of which is performed at the patient as well as hospitalization level. Error is assessed with respect to diagnosis, race, age, gender, AKI identification method, and hospital utilization. In an additional experiment, the regularization penalty is severely increased to induce parsimony and interpretability. Predictors identified for rehospitalized patients are also reported with a special analysis of medications that might be modifiable risk factors. Insights from this study might be used to construct a predictive tool for AKI in rehospitalized patients. An accurate estimate of AKI risk at hospital entry might serve as a prior for an admitting provider or another predictive algorithm.

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“…The protective effect of intravenous anesthetic agents with a short duration on the liver and kidneys would be associated with non-specific histopathologic findings (36)(37)(38).…”

Section: Discussionmentioning

confidence: 99%

The effect of repetitive exposure to intravenous anesthetic agents on the immunity in mice

et al. 2020

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Introduction: This study was designed to assess the effect of repetitive exposure to intravenous anesthetic agents on the immunity in mice. Materials and Methods: The mice were divided into six groups: three intravenous anesthetic agents groups (dexmedetomidine, midazolam and propofol groups), and three corresponding control groups (CD, CM, and CP groups). The intravenous injections were administered once per day for 5 days. The immunity of mice was checked after the last intravenous injection. Histopathology and immunochemistry of liver and kidneys were evaluated. Cytokine levels in the blood was also checked. vs. evaluated with cytokine levels in the blood. Results: Cluster of differentiation (CD)4 + T cells were significantly less expressed in dexmedetomidine and propofol groups, compared with the corresponding control groups [34.08 ± 5.63% in the dexmedetomidine group vs. 59.74 ± 8.64% in the CD group, p < 0.05; 25.28 ± 7.28% in the propofol group vs. 61.12 ± 2.70% in the Cp group, p < 0.05]. Apoptosis of CD4 + T cells was increased significantly in dexmedetomidine and propofol groups, compared with the corresponding control groups. Histopathological findings of liver and kidneys did not show any specific differences of any of three intravenous anesthetic agents groups with their corresponding control groups, although immunohistochemical examination indicated significantly lower expression of Toll-like receptor-4 from liver and kidneys in dexmedetomidine and propofol groups. The cytokine levels were not different between the groups. Conclusion: Repetitive exposure to dexmedetomidine and propofol reduced the expression of CD4 + T cells but did not induce any significant liver or kidney injuries.

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Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Cited by 29 publications

References 21 publications

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

Predicting acute kidney injury at hospital re-entry using high-dimensional electronic health record data

The effect of repetitive exposure to intravenous anesthetic agents on the immunity in mice

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