scholarly journals DOES CONCOMITANT ADMINISTRATION OF DEXMEDETOMIDINE AND PROPOFOL PROVIDE MYOCARDIAL PROTECTION AND RENAL FUNCTION PRESERVATION IN COMPARISON TO PROPOFOL ALONE; A RANDOMIZED PROSPECTIVE STUDY

2021 ◽  
Vol 54 (1) ◽  
pp. 44-50
Author(s):  
Muhammad Farhan Ali Rizvi ◽  
Sajid Farooq ◽  
Sana Urooj Hashmi ◽  
Hafiz Muhammad Salman Yousaf ◽  
Hafiz Syed Muhammad Irfan Yousaf ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Renal Function ◽  
Creatinine Clearance ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Concomitant Administration ◽  
Hemodynamic Parameters ◽  
Function Preservation ◽  
Insignificant Difference

Objective: To ascertain the safety and efficacy of concomitant administration of dexmedetomidine and propofol in maintaining myocardial protection and renal function integrity in comparison to propofol alone in adult cardiac surgical patients. Methodology: A randomized clinical trial was conducted at cardiac center Bahawalpur from June 2018 to January 2020. Study included 64 patients who underwent coronary artery bypass grafting (CABG). Two groups, DP (DEXMEDETOMIDINE (DEX) +Propofol) and P (Propofol alone) were made by allocating 32 patients in each group. Hemodynamic parameters (Heart rate, Diastolic blood pressure (DBP), systolic blood pressure (SBP) and mean arterial pressure (MAP) at different time intervals throughout the surgery were measured, pre and post-operative CKMB, any arrhythmias, events of tachycardia and bradycardia were recorded and renal parameters (urine output immediate post pump and 4 hours post pump, creatinine clearance of day 1 and day 2) were measured. Results: DP group showed stable hemodynamics with values of hemodynamic parameters were lesser and statistically significant than patients in group P (Heart rate (p<.05), DBP (P<.05), SBP (P<.05) and MAP (p<.05). Both groups showed insignificant difference in terms of incidence of arrhythmias (p=0.325), Post-operative CKMB (P=0.512), events of tachycardia (p=0.6) and bradycardia (p=0.5).Immediate post pump urine was statistically significant (p<.05), however, 4-hour post pump urine (p = 0.45), creatinine clearance of day 1 (p = 0.8) and day 2 (p =.092) were comparable. Conclusion: Concomitant administration of dexmedetomidine and propofol provide adequate cardioprotection by maintaining stable hemodynamics in comparison to propofol alone, however they did not prove to be effective renoprotective agents.  

MO233RENAL ARTERY STENOSIS: DO NOT FORGET INHERITED THROMBOPHILIA

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marwa Omrane ◽  
Yosra Ben Ariba ◽  
Imen Ouertani ◽  
Jannet Labidi
Keyword(s):  
Blood Pressure ◽  
Renal Function ◽  
Renal Artery ◽  
High Blood Pressure ◽  
Protein C ◽  
Artery Bypass ◽  
Duplex Ultrasound ◽  
Protein S ◽  
Artery Stenosis ◽  
Inherited Thrombophilia

Abstract Background and Aims Inherited thrombophilia can be defined as a genetically determined predisposition to develop thromboembolic complications. Inherited prothrombotic risk factors include antithrombin deficiency, protein C and protein S deficiencies, activated protein C resistance due to Leiden factor V mutation, inherited hyperhomocysteinemia, prothrombin G20210A variant, dysfibrinogenemia and elevated factor VIII levels. Method We report the case of a patient with history of bilateral renal artery stenosis who presented with renal artery bypass thrombosis related to an inherited thrombophilia. Results We report a case of 40-year-old male patient who presented with extremely high blood pressure and hypokalemia without other biological abnormalities. The duplex ultrasound showed bilateral renal stenosis with chronic occlusion of the right renal artery and a tight stenosis of the left renal artery estimated at 50%. Renal angiography confirmed the bilateral stenosis, associated to a small right kidney. Renal scintigraphy with DMSA showed normal left renal function and right renal function estimated at 2%. The therapeutic decision was to perform an aorto-renal bypass surgery by the saphenous vein.After renal artery bypass the blood pressure improved markedly, maintaining this result at 12 months follow-up at clinical examination and duplex ultrasound. One year later, the patient presented with high blood pressure. The duplex ultrasound showed a stenosis of the bypass with a double stenosis of the left aorto renal bypass on renal angioscanner. The patient underwent angioplasty of the venous bridge with implantation of 2 stents with improvement of blood pressure after angioplasty. Six months later, the patient presented an unbalanced blood pressure, the ultrasound control with a vascular Doppler showed a stenosis at the stent. The antihypertensive treatment was increased, a thrombophilia balance was requested concluding a combined protein C and protein S deficiency. Conclusion An etiological assessment should be carried out systematically in the event of thrombosis occurring before the age of 40 or in the case of iterative venous or arterial thrombosis. A genetic study where appropriate and a family screening are then recommended.

scholarly journals Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance

2013 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Rodney H. Breau ◽  
Aaron T.D. Clark ◽  
Chris Morash ◽  
Dean Fergusson ◽  
Ilias Cagiannos
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Function Change ◽  
Tumour Location ◽  
Function Preservation ◽  
The Mean ◽  
The Impact

Background: Radiographic characteristics may be associated withthe degree of renal function preservation following partial nephrectomy.The purpose of this study was to determine the impact ofpreoperative radiographic variables on change in renal functionusing 24-hour urine creatinine clearance (uCrCl).Methods: Patients with partial nephrectomy performed fromNovember 2003 to 2008 were enrolled in the study. Serum creatinineand 24-hour urine was collected preoperatively and at3, 6 and 12 months postoperatively. Computed tomography ormagnetic resonance imaging was used to determine tumour size,tumour location and renal volume.Results: Of the 36 patients, median age was 62 (range 30-78) and21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm.Twenty-two (61%) tumours were located at the renal pole and11 (31%) were endophytic. Overall, mean preoperative uCrClwas 88.8±34.2 mL/min and mean postoperative uCrCl was82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis,no single characteristic was associated with a clinically prohibitivedecrease in renal function (-9.4% if endophitic, p = 0.06; -0.57%per cm diameter, p = 0.73; and -6.9% if located at the renal pole,p = 0.15). The total renal volume was also not significantly associatedwith renal function change (-1.1% per 100 cc, p = 0.86).Interpretation: Preoperative radiographic characteristics seem tobe associated with small changes in renal function following partialnephrectomy. These data support renal functional benefits of partialnephrectomy regardless of tumour size and location.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

scholarly journals The ocular cardiac reflex effect study on cardiac hemodynamic parameters in healthy young mans.

2019 ◽  
Vol 40 (1) ◽  
pp. 17-24
Author(s):  
A. I. Palamarchuk
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Blood Flow ◽  
Cardiovascular System ◽  
Peripheral Resistance ◽  
Blood Flow Rate ◽  
Effect Study ◽  
Nonlinear Dependence ◽  
System Response ◽  
Hemodynamic Parameters

Purpose of the study. Investigate changes of cardiac hemodynamic parameters caused by ocular cardiac reflex triggering in healthy men’s in youthful age.Material and methods. 120 healthy male volunteers in youthful age were examined. The mean age was (19,2 ± 0,93 years). For ocular-cardiac reflex (OCR) triggering we used a patented model «Device for dosed compression effects on the eyeballs» and «The method of ocular cardiac reflex triggering». On the basis of the obtained parameters of systolic (SBP) and diastolic (DBP) blood pressure, by arithmetic operations, pulse pressure (PP) and average flow pressure (AFP) and integrative parameters of cardiohemodynamics (CHD) – systolic blood volume (SBV), minute blood flow volume (MBFV), volumetric blood flow rate (V), total peripheral resistance (TPR) were determined. Results. Three main types of cardiovascular system response on OCR triggering were identified. The first type – hypertensive (n = 30 (25%) of the total number of examined subjects) was characterized by a significant (p < 0,05) increase in heart rate, SBP, DBP, PP, AFP and other integrative parameters of CHD. The second, hypotonic type of the response (62 subjects; 51,7%) was characterized by a significant (p < 0,05) decrease in SBP, DBP, PP, AFP. Patients with third, dystonic type, of response (n = 28 (23,3%) of the total number examined subjects) showed significant bilateral changes of blood pressure parameters in a nonlinear dependence of compression power on the eyeballs. Determination CHD parameters directly after and 3 and 5 minutes after decompression of the air in the compression device we enabled to determine the subtype of the mobility of the nervous centers as a feature that complements the basic type. The subtype of normal mobility was revealed in 63,3% (n = 19) of subjects with the main hypertensive type of response, 69,3% (n = 43) of subjects with the main hypotonic and 60,7 % (n = 17) with the main dystonic type of response of the cardiovascular system. The inert subtype in the mobility of the cardiovascular system were identified in 36,7% (n = 11) individuals with hypertension is the main type of response, at 30,7% (n = 19) of individuals with primary hypotonic type of response and 39,3 % (n = 11) – distancing. The obtained typological changes in blood pressure parameters caused by OCR triggering allowed to reveal predisposition to hypertension, hypotension, dystonia and to predict the development of hypertension in patients with hypertensive type of response usin appropriate primary prevention changes in life style. The highest risk of hypertension development may be in persons with hypertensive inert type of reaction of the system of regulation of blood pressure on OCR triggering. Further studies are being conducted to confirm this assumption. Keywords: oculo-cardiac reflex, blood pressure, heart rate, young age.

Renal function after off-pump versus on-pump coronary artery bypass grafting

2017 ◽  
Vol 25 (7-8) ◽  
pp. 504-508 ◽  
Author(s):  
Rana Sandip Singh ◽  
Shyam Kumar Singh Thingnam ◽  
Anand Kumar Mishra ◽  
Indu Verma ◽  
Vikas Kumar
Keyword(s):  
Renal Function ◽  
Coronary Artery ◽  
Creatinine Clearance ◽  
Renal Dysfunction ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

Background Renal dysfunction is a well-recognized major complication after coronary artery bypass grafting. Off-pump coronary artery bypass theoretically appears to have less impact on renal function. We estimated preoperative and postoperative creatinine clearance as a marker of renal dysfunction in patients undergoing off-pump and on-pump coronary artery bypass. Methods Thirty patients undergoing coronary artery bypass were randomly allocated to undergo either on-pump ( n = 15) or off-pump surgery ( n = 15). The two groups had similar preoperative demographic characteristics. Serum creatinine and creatinine clearance were measured for 4 days postoperatively and the results were compared with preoperative levels. Results The rise in serum creatinine on postoperative day 1 was 0.28 mgċdL−1 in the on-pump group and 0.22 mgċdL−1 in the off-pump group ( p = 0.27); on postoperative day 4 it was 0.15 mgċdL−1 and 0.10 mgċdL−1, respectively, ( p = 0.28). Similarly, the fall in creatinine clearance was 17.34 mLċmin−1 in the on-pump group and 19.62 mLċmin−1 in the off-pump group on postoperative day 1 ( p = 0.42), and 10.9 and 10.94 mLċmin−1, respectively, on postoperative day 4 ( p = 0.64). Conclusion Renal function is not affected by the technique of coronary artery bypass surgery, whether with or without cardiopulmonary bypass, in spite of the theoretical advantage of off-pump surgery. Our study suggests that off-pump coronary artery bypass surgery does not confer significant protection from postoperative renal dysfunction in low-risk patients, when compared with on-pump surgery.

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