Continuation vs Discontinuation of Renin-Angiotensin System Inhibitors Before Major Noncardiac Surgery

JAMA, Journal Year: 2024, Volume and Issue: 332(12), P. 970 - 970

Published: Aug. 30, 2024

Before surgery, the best strategy for managing patients who are taking renin-angiotensin system inhibitors (RASIs) (angiotensin-converting enzyme or angiotensin receptor blockers) is unknown. The lack of evidence leads to conflicting guidelines.

Language: Английский

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Protective hemodynamics: a novel strategy to manage blood pressure

Current Opinion in Critical Care, Journal Year: 2024, Volume and Issue: 30(6), P. 629 - 636

Published: Sept. 7, 2024

Purpose of review This editorial aims to highlight the evolving concept protective hemodynamics in management critically ill patients. Recent findings literature underscores limitations rigid blood pressure targets, particularly context critical care and perioperative management. High especially when coupled with high-dose vasopressors, can lead poor outcomes. ’Protective hemodynamics’ maintain cardiovascular stability while reducing risks associated interventions. Summary The implications adopting are profound for both clinical practice research. Clinically, this approach reduce iatrogenic harm improve long-term outcomes For research, it opens new avenues investigating individualized hemodynamic strategies that prioritize overall patient health over target attainment.

Language: Английский

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Protective haemodynamics: C.L.E.A.R.!

Journal of Cardiothoracic and Vascular Anesthesia, Journal Year: 2024, Volume and Issue: unknown

Published: Oct. 1, 2024

Language: Английский

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Perioperative fluid management: evidence-based consensus recommendations from the international multidisciplinary PeriOperative Quality Initiative

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 1, 2024

Language: Английский

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Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery: a retrospective cohort analysis

British Journal of Anaesthesia, Journal Year: 2024, Volume and Issue: 134(1), P. 54 - 62

Published: Dec. 12, 2024

Intraoperative hypotension is associated with acute kidney injury (AKI). Clinicians thus frequently use vasopressors, such as norepinephrine, to maintain blood pressure. However, vasopressors themselves might promote AKI. We sought determine whether both intraoperative and cumulative norepinephrine dose are independently postoperative AKI in patients undergoing noncardiac surgery. This was a retrospective cohort analysis of 38 338 adult male female who had The primary outcome within the first 7 days. performed adjusted multivariable logistic regression (quantified area under mean arterial pressure [MAP] 65 mm Hg) were median (25th percentile, 75th percentile) MAP Hg 0.09 (0.02, 0.22) Hg∗day 0.05 (0.01, 0.14) without (P<0.001). 1.92 (0.00, 13.09) μg kg-1 0.00 0.00) Both (odds ratio 1.55 [95% confidence interval 1.17-2.02] per Hg∗day; P=0.002) 1.02 1.01-1.02] kg-1; P<0.001) Pending results trials testing these relationships causal, it seems prudent avoid profound high doses adults

Language: Английский

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Effects of Blood Pressure Management Based on Non-Invasive Heart Function Monitoring on Reducing Postoperative Hypotension in Elderly Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Trial

The Journal of Arthroplasty, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

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The Decision to Interrupt Renin-Angiotensin System Inhibitors Before Surgery Should Be Individualized

A&A Practice, Journal Year: 2025, Volume and Issue: 19(2), P. e01911 - e01911

Published: Feb. 1, 2025

Ho, Anthony M.-H. MD, FRCPC, FCCP; Mizubuti, Glenio B. PhD, FRCPC; Phelan, Rachel MSc; Klar, Gregory Leitch, Jordan Cupido, Tracy DO, Fleming, Melinda Azargive, Saam MD; Arellano, Ramiro L. MSc, FRCPC Author Information

Language: Английский

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Association of intraoperative hypotension and cumulative norepinephrine dose with postoperative acute kidney injury in patients having noncardiac surgery. Comment on Br J Anaesth 2024; 134: 54–62

British Journal of Anaesthesia, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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Clinical comparative study of the modified superior mesenteric artery approach in total laparoscopic radical resection for right colon cancer - a single-center retrospective study

World Journal of Surgical Oncology, Journal Year: 2025, Volume and Issue: 23(1)

Published: Feb. 27, 2025

To explore the safety and feasibility of modified approach for accessing superior mesenteric artery (SMA) in total laparoscopic radical resection right colon cancer. This single-center retrospective study included 107 patients who underwent cancer at The First Affiliated Hospital Wannan Medical College between August 2022 December 2023. 53 were SMA (modified group) 54 traditional (control group). control group cancer, following baseline pathological characteristics two groups compared: intraoperative condition, postoperative recovery, complications. Our surgical method was to isolate mesocolon using a cranial(the ligament Treitz) -to- caudal(the pedicle ileocolic) pathway orderly ligation blood vessels SMA. There no statistically significant difference or data groups. Compared with approach, had shorter time(P < 0.001) vascular dissection time (P less loss = 0.000). number harvested lymph nodes positive > 0.05); hospital stay, first flatus, pull out drainage tube 0.05), there incidence complications 0.05). totally can shorten time, reduce bleeding difficulty risk In clinical practice, its are relatively high, it is worth promoting. approved by Ethics Committee registered China Clinical Trials Registry (ChiCTR2300075919, Date Registration:2023-09-19- registration) http://www.chictr.org.cn/index.aspx .

Language: Английский

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Haemodynamic monitoring and management during non-cardiac surgery: a survey among German anaesthesiologists

Journal of Clinical Monitoring and Computing, Journal Year: 2025, Volume and Issue: unknown

Published: March 22, 2025

Abstract In 2023, the first German guideline on intraoperative haemodynamic monitoring and management for adults having non-cardiac surgery was published. The aim of this survey to identify how anaesthetists in Germany managed haemodynamics blood pressure before its publication. September October members Society Anaesthesiology Intensive Care Medicine (DGAI) were invited via email participate anonymous online survey. Thirty-one questions covered demographics, clinical experience, approaches perioperative measurement common thresholds, as well use advanced potential therapeutic implications. 1,079 fully completed questionnaires included analysis. When intermittent oscillometry used measure pressure, a 3-minute interval usually applied during induction anaesthesia (42%; 451/1,079). For invasive monitoring, more than half (53%; 574/1,079) inserted an arterial line after anaesthesia. Nearly all (94%; 1,012/1,079) focused mean with large majority (77%; 779/1012) considering values below 60–65 mmHg be critically low. Intraoperative hypotension based internal protocol by only 21% (223/1,079). Regarding 43% (459/1,079) frequently pulse contour analysis, while 67% (721/1,079) reported that monitors finger-cuff technology not available their department. 47% (504/1,079) cited lack experience one main reasons infrequent cardiac output monitoring. This among DGAI provides important insights into current practices prior publication recent ‘Intraoperative surgery’.

Language: Английский

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