The influence of propofol-based total intravenous anesthesia on postoperative outcomes in end-stage renal disease patients: A retrospective observation study

Abstract

Background To determine whether the anesthetic method of propofol total intravenous anesthesia (TIVA) is associated with postoperative outcome in ESRD patients, we evaluated the incidence of postoperative major adverse cardiac events (MACE), comparing propofol TIVA versus anesthesia with volatile anesthesia in ESRD patients. Methods Retrospectively, we identified cases with ESRD patients who underwent surgery under general anesthesia. Patients were divided into those who received only volatile anesthesia (volatile group) and those who received only propofol TIVA (TIVA group). The incidence of MACE and potential confounding variables were compared separately in a univariate logistic model and subsequently by multivariate logistic regression. Results Among the 2576 cases in ESRD patients, 1374 were in the TIVA group and 1202 were in the volatile group. The multivariate analysis included 12 factors, including the anesthesia method, of which five factors were significant. Factors that were associated with a significantly lower MACE risk included preoperative chloride concentration (OR: 0.96; 95% CI, 0.92–0.99), baseline SBP (OR: 0.98; 95% CI, 0.98–0.99), and propofol TIVA (OR: 0.37; 95% CI, 0.22–0.60). Conclusions We inferred that the anesthetic method associated with the postoperative outcome in patients with ESRD.

Effect of Remimazolam on Induction and Maintenance of General Anesthesia in Kidney Transplant Patients

“… 15 On the one hand, propofol was used in patients with end-stage renal disease, and the plasma clearance rate was comparable to that of healthy subjects; however, it is important to pay attention to the use of dosage, as it may cause fluctuations in hemodynamics. 16 On the other hand, propofol has the effect of inhibiting myocardial contractility and dilating peripheral blood vessels, which significantly inhibits the circulatory system. 17 But no such mechanism has been found in remimazolam yet.…”