CEREBRALANEURYSM SURGERY IN A PATIENT WITH CHRONIC RENAL FAILURE: PERIOPERATIVE CONCERNS AND CONFLICTS

2021 ◽  
pp. 58-59
Author(s):  
Izhar Faisal ◽  
Pragati Ganjoo
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Hemodynamic Instability ◽  
Electrolyte Imbalance ◽  
Anesthetic Drug ◽  
Hemodynamic Stability ◽  
Anesthetic Drugs ◽  
Coagulation Abnormalities ◽  
Brain Relaxation ◽  
Drug Doses

Chronic renal failure (CRF) and associated multi-system abnormalities can adversely impact the outcome in patients undergoing high-risk aneurysm surgeries by causing hemodynamic instability, uid-electrolyte imbalance, bleeding and coagulation abnormalities, decreased anesthetic drug excretion, and dialysis-related complications. Conicts between the standard perioperative practices in aneurysm surgery and those in CRF further contribute to the management challenges. These include, using low anesthetic drug doses but achieving good brain relaxation, using a restrictive uid therapy but preventing postoperative vasospasm, and avoiding diuretics causing nephrotoxicity but reducing intracranial pressure. Ayoung male with dialysis-dependent CRF and hypertension underwent emergency craniotomy and clipping of a cerebral aneurysm. He was managed with a modied protocol of reduced heparin hemodialysis, BIS-guided use of minimum anesthetic drugs, goal-directed optimum uid therapy, maintaining hemodynamic stability, and management of post-aneurysm clipping vasospasm with hypertension. His perioperative management and related conicts are discussed

scholarly journals THE COMPARISON OF ETOMIDATE AND PROPOFOL FOR ATTENUATION OF HAEMODYNAMIC RESPONSE TO INDUCTION AND ENDOTRACHEAL INTUBATION

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Virendra Singh Rathore ◽  
Suresh Pandey ◽  
S.P. Chittora
Keyword(s):  
Renal Failure ◽  
Informed Consent ◽  
General Anesthesia ◽  
Endotracheal Intubation ◽  
Surgical Procedures ◽  
Cardiac Surgical Procedures ◽  
Hemodynamic Instability ◽  
Hemodynamic Stability ◽  
Medical College ◽  
Written Informed Consent

Background: This study is designed to compare the degree of attenuation of hemodynamic response to induction, laryngoscopy and endotracheal intubation of etomidate with those of propofol in patients undergoing noncardiac surgical procedures. Methods:  The present study conducted in Non Cardiac Surgeries in the Department of Anaesthesiology, Jhalawar Medical College & Associated Hospitals, Jhalawar, Rajasthan.After institutional ethical committee’s approval and written informed consent from the patient’s attendant in the format as per proforma, the present study was conducted on 60  patients of ASA Grade I and II of either sex, aged 18 to 60 years, scheduled for a variety of non-cardiac surgical procedures requiring general anaesthesia. Results: The findings of the study suggest that use of etomidate as inducing agent provides more hemodynamic stability as compared to propofol and can be preffered in patients prone to hemodynamic instability, cardiovascular abnormalities, hypovolemia, prone to renal failure due to hypotension. Propofol may be preffered for induction where hypertension is contraindicated or hypotension is preffered and myoclonus is to be avoided. Conclusion: Etomidate provides a more stable hemodynamics during general anesthesia as compared to propofol. Keyword:- Etomidate, Propofol, Hemodynamic.

Fluids and renals

2014 ◽  
Author(s):  
Tim Raine ◽  
James Dawson ◽  
Stephan Sanders ◽  
Simon Eccles
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Artery ◽  
Kidney Injury ◽  
Artery Occlusion ◽  
Electrolyte Imbalance ◽  
Serum Urea ◽  
Renal Artery Occlusion ◽  
Urological Disorders

Acute kidney injuryChronic renal failureHaematuriaProteinuriaGlomerular diseaseUrological disordersLow urine outputIV fluidsPotassium emergenciesElectrolyte imbalanceAcute rise from baseline of serum urea and creatinine ±oliguria ( Table 12.1);1there are three basic mechanisms:•Prerenal hypoperfusion of kidney due to eg ↓BP, hypovolaemia, renal artery occlusion (mass, emboli)...

scholarly journals PERAN HEMODIALISIS TERHADAP KADAR KREATININ DARAH PASIEN GAGAL GINJAL KRONIK

2021 ◽  
Vol 3 (1) ◽  
pp. 28
Author(s):  
I Gede Purnawinadi
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Kidney Function ◽  
Electrolyte Imbalance ◽  
Bivariate Analysis ◽  
High Tech ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Paired Sample ◽  
Purposive Sampling

Hemodialisis merupakan terapi pengganti fungsi ginjal berteknologi tinggi dalam upaya mengeluarkan sisa-sisa metabolisme atau racun tertentu dari peredaran darah dengan tujuan utama menghilangkan gejala dengan mengendalikan kadar ureum dan kreatinin dalam darah, kelebihan cairan dan ketidakseimbangan elektrolit yang terjadi pada pasien dengan kondisi gagal ginjal kronik. Penelitian ini bertujuan menambah pemahaman tentang peran dan manfaat hemodialisis melalui analisis perbandingan kadar kreatinin serum pre dan post hemodialisis pada pasien gagal ginjal kronik di unit hemodialisa RSUP. Prof. DR. R. D. Kandou Manado. Metode penelitian yang dilakukan adalah kuantitatif komparatif dengan pendekatan cross sectional. Pengambilan sampel menggunakan teknik purposive sampling. Data yang terkumpul akan diolah dan dianalisis menggunakan komputer program microsoft excel dan program Statistical Product and Service Solutions (SPSS). Data dianalisis secara univariat mencari nilai rata-rata dan analisis bivariat dengan paired sample t-test. Hasil penelitian membuktikan hemodialisis mempunyai pengaruh yang signifikan dalam upaya menurunkan kadar kreatinin darah yang berlebihan pada pasien dengan gagal ginjal kronik (p=0,000<0,005). Untuk penelitian selanjutnya terkait peran hemodialisis diharapkan dapat menganalisis variabel lainnya seperti kadar ureum dan lain-lain sebagai indikator fungsi ginjal.  Kata kunci: hemodialisis, kreatinin, gagal ginjal kronik   Hemodialysis is a substitute therapy for high-tech kidney function in an effort to remove metabolic remnants or certain poisons from the bloodstream with the main goal of relieving symptoms by controlling ureum and creatinine levels in the blood, fluid overload, and electrolyte imbalance that occurs in patients with chronic kidney failure. This study aims to increase understanding of the role and benefits of hemodialysis through a comparative analysis of serum creatinine levels pre and post hemodialysis in patients with chronic renal failure in the hemodialysis unit of the General Hospital. Prof. DR. R. D. Kandou Manado. The research method used is comparative quantitative with cross-sectional approach. Sampling using a purposive sampling technique. The collected data is processed and analyzed using Microsoft Excel computer programs and Statistical Product and Service Solutions (SPSS) programs. Data were analyzed univariately by looking for mean and bivariate analysis with paired sample t-tests. The results showed that hemodialysis had a significant effect in reducing excessive blood creatinine levels in patients with chronic renal failure (p = 0.000 <0.005). For further research related to the role of hemodialysis, it is hoped that other variables can be analyzed such as urea levels and others as indicators of kidney function. Keywords: hemodialysis, creatinine, chronic renal failure

scholarly journals Correlation between serum electrolyte levels and brain stem evoked response audiometry in chronic renal failure: a pilot study

2020 ◽  
Vol 6 (11) ◽  
pp. 2050
Author(s):  
Manish Munjal ◽  
Karanpreet Singh ◽  
Parth Chopra ◽  
Shubham Munjal ◽  
Hemant Chopra ◽  
...  
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Serum Creatinine ◽  
Brain Stem ◽  
Normal Serum ◽  
Evoked Response ◽  
Electrolyte Imbalance ◽  
Medical College ◽  
Brain Stem Evoked Response ◽  
Evoked Response Audiometry

<p class="abstract"><strong>Background:</strong> The effect of electrolyte imbalance on hearing thresholds and its objective manifestation, as delayed latencies or inter-peak intervals in evoked response audiometry is studied.</p><p class="abstract"><strong>Methods:</strong> The present prospective study was undertaken in a period of one and a half years, to analyze the audiological profile in patients of chronic renal failure and renal allograft recipients. 60 patients were randomly selected from the out- patient and indoor services of nephrology, urology and oto-rhino-laryngology, Dayanand Medical College and Hospital, Ludhiana. Brain stem evoked response audiometry was performed and the latencies were tabulated.  </p><p class="abstract"><strong>Results:</strong> A significant delay in the absolute latency of wave V was noted in hyponatremic patients of CRF on comparison with patients of CRF having a normal serum Na<sup>+</sup> levels. The I-V interpeak interval was also seen to be significantly delayed on comparison. A statistically significant delayed I-III inter-peak latency was also observed in hypernatremic patients in comparison to patients having a serum Na<sup>+</sup> level in the normal range. No significance of serum creatinine levels and wave latencies was noted on comparison between the three categories of patients of CRF as categorized by their serum creatinine levels.</p><p class="abstract"><strong>Conclusions:</strong> There is a definite deterioration of the audiological function in patients of chronic kidney disease, and some reversal of these abnormalities following a successful renal transplantation; indirectly pointing towards uremic milieu being the culprit.</p>

HIV: renal disorders

2019 ◽  
pp. 581-588
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Renal Dysfunction ◽  
Direct Effect ◽  
Renal Disorders ◽  
Failure Assessment ◽  
Drug Doses

This chapter provides an overview of renal problems seen in patients who live with HIV. It outlines the causes of renal dysfunction, including acute and chronic renal failure. Assessment of a patient presenting with renal failure is discussed. The direct effect of HIV on the kidney is discussed. The effect of drugs on the kidneys and the need to modify drug doses are discussed.

scholarly journals Comparison of the effects of inhalation anesthetics in the intraand postoperative periods during kidney transplantation

2020 ◽  
Vol 12 (2) ◽  
pp. 94-103
Author(s):  
N. K. Kuznetsova ◽  
V. E. Aleksandrova ◽  
I. I. Utkina ◽  
A. M. Talyzin ◽  
S. V. Zhuravel
Keyword(s):  
Renal Failure ◽  
Kidney Transplantation ◽  
Chronic Renal Failure ◽  
Hemodynamic Instability ◽  
Low Flow ◽  
Minimal Amount ◽  
Inhalation Anesthesia ◽  
Inhalation Anesthetics ◽  
Inhalation Anesthetic ◽  
Number Of Patients

Background. Every year the number of patients with chronic renal failure is steadily increasing. Allogeneic kidney transplantation from a post-mortem donor is a radical method to cope with chronic renal failure, improving the quality and life expectancy of patients. Currently available inhalation anesthetics make it easy to control the depth of anesthesia; they are excreted by the lungs unchanged, providing a quick emergence from anesthesia and easy waking up of the patient. An “ideal” inhalation anesthetic used for kidney transplantation should have a minimal amount of adverse effects.The aim was to compare the efficacy of inhaled anesthetics used for allogeneic kidney transplantation from a posthumous donor.Material and methods. A randomized, prospective, single-center study included 62 patients with end-stage chronic renal failure. The subjects were divided into three groups depending on the type of the inhalation anesthetic used. The first group included patients who underwent low-flow inhalation anesthesia with desflurane, the second and third groups were comparator groups where patients received sevoflurane or isoflurane, respectively, as an inhalation anesthetic. When assessing hemodynamic parameters, most episodes of hemodynamic instability were seen in the isoflurane group; the most stable statistically significant values were observed in the sevoflurane group, and desflurane took an intermediate position.Results. The use of desflurane as an inhalation anesthetic in a kidney transplant provided a quicker recovery of consciousness and early extubation of the patient after anesthesia compared to the sevoflurane or isoflurane use. So desflurane proved to be the most efficient of the three studied inhalation anesthetics. Conclusion. Desflurane is the optimal inhalation anesthetic used in kidney transplantation.

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