The role of hydroxyethyl starch in perioperative acute kidney injury. Comment on Br J Anaesth 2024; 133: 1263–75

British Journal of Anaesthesia, Год журнала: 2025, Номер unknown

Опубликована: Янв. 1, 2025

Язык: Английский

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A Retrospective Study on the Role of Tranexamic Acid in Reverse Total Shoulder Arthroplasty for Trauma Patients With Complex Proximal Humerus Fractures

Cureus, Год журнала: 2025, Номер unknown

Опубликована: Янв. 27, 2025

Background The role of tranexamic acid (TXA) in primary elective hip, knee, and shoulder arthroplasty is well established. This a retrospective study, which explores the efficacy TXA proximal humerus fractures (PHF) requiring arthroplasty. Design methods Patients undergoing reverse total (RSA) for PHF between January 2022 May 2024 Queen Elizabeth Hospital (QEH), Birmingham, UK were identified. administered 1 g intravenous injection preoperatively during anesthetics induction. parameters reviewed included changes hemoglobin (Hb) levels from preoperative to postoperative, postoperative blood transfusion rates, length hospital stay. Results Out 78 patients, 35 (45%) patients received whereas 43 (55%) did not receive preoperatively. No significant drop Hb was observed (TXA: 1.7 ± 1.2 g/dL vs. non-TXA: 2.0 1.3 g/dL, P = 0.30). Seven out (8.9%) required (3 4 (non-TXA); 6 (86%) females (14%) males). In cohort, both groups longer stay postoperatively 20.3 + 16.0 days 18.5 14.8 days, 0.88). Conclusion Intravenous associated with decrease reduction trauma RSA PHF. Females are at greater risk despite administration. Future studies should consider investigating dose-dependent on RSA.

Язык: Английский

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Synthetic colloids as priming fluids in cardiopulmonary bypass and postoperative acute kidney injury: a propensity score-matched study

Perioperative Medicine, Год журнала: 2025, Номер 14(1)

Опубликована: Фев. 22, 2025

The optimal fluid management strategy for patients undergoing on-pump cardiac surgery was controversial regarding the types. This study aimed to compare impact of hydroxyethyl starch (HES) and succinylated gelatin on postoperative acute kidney injury (AKI). is a single-center, retrospective study. Adult with cardiopulmonary bypass (CPB) between 2018 2022 were included. Patients grouped by priming solution used: HES (the group) or group). primary outcome incidence AKI, secondary outcomes included continuous renal replacement therapy (CRRT), blood transfusions, myocardial infarction, lung infection, cerebrovascular events, chest drainage, duration mechanical ventilation, intensive care unit (ICU) stay, in-hospital mortality, associated costs. Propensity score matching (PSM) conducted adjust characteristic differences two groups. A total 14,443 After 1:1 propensity matching, 1880 pairs analyzed. Baseline characteristics comparable matched AKI significantly lower in group (3.0% vs. 5.1%, P = 0.001). No significant found transfusion requirements after score-matching. use independently increased odds (adjusted ratio [aOR], 1.785; 95% CI, 1.262–2.526; effects occurrence greater elderly female patients. as an risk compared gelatin, although it did not affect requirements. These findings highlight importance considering type during surgery.

Язык: Английский

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Intra-operative haemodynamic monitoring and management of adults having noncardiac surgery

European Journal of Anaesthesiology, Год журнала: 2025, Номер 42(6), С. 543 - 556

Опубликована: Май 1, 2025

This article was developed by a diverse group of 25 international experts from the European Society Anaesthesiology and Intensive Care (ESAIC), who formulated recommendations on intra-operative haemodynamic monitoring management adults having noncardiac surgery based review current evidence. We recommend basing arterial pressure mean keeping above 60 mmHg. further identifying underlying causes hypotension addressing them appropriately. suggest pragmatically treating bradycardia or tachycardia when it leads to profound likely results in reduced cardiac output, oxygen delivery organ perfusion. stroke volume output patients with high baseline risk for complications high-risk assess status response therapeutic interventions. However, we not routinely maximising surgery. Instead, defining targets individually each patient considering clinical situation metabolic signs tissue perfusion oxygenation. giving fluids simply because is fluid responsive but only if there are hypovolaemia hypoperfusion. optimising depth anaesthesia titrate doses anaesthetic drugs reduce their side effects.

Язык: Английский

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Goal-directed therapy: what is the goal again?

Perioperative Medicine, Год журнала: 2025, Номер 14(1)

Опубликована: Май 16, 2025

Recent attention has focused on intraoperative hypotension (IOH) and hemodynamic instability. This enhanced awareness to limit IOH, combined with fluid restriction increased vasopressor use, been associated an increase in postoperative acute kidney injury. literature supports improved monitoring of mean arterial pressure (MAP), management, appropriate use vasopressors inotropic support for management. Implementing algorithm manage the causes IOH minimizes iatrogenic harm by guiding anesthesia clinicians select interventions at optimal time. ensures a comprehensive evaluation contributing factors such as deficits, myocardial depression, vasodilation. Shifting from MAP displayed physiologic monitor more individualized care goal-directed therapy approach may improve patient outcomes.

Язык: Английский

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In Response

Anesthesia & Analgesia, Год журнала: 2025, Номер unknown

Опубликована: Май 22, 2025

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The need for rigour in consensus statements and guidelines

British Journal of Anaesthesia, Год журнала: 2024, Номер 133(6), С. 1123 - 1125

Опубликована: Окт. 2, 2024

Язык: Английский

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Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery. Response to Br J Anaesth 2024

British Journal of Anaesthesia, Год журнала: 2024, Номер 134(1), С. 255 - 256

Опубликована: Дек. 5, 2024

Язык: Английский

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Perioperative fluid management: why one-size-fits-all strategies are insufficient in high-risk patients. Comment on Br J Anaesth 2024; 133: 1263–75

British Journal of Anaesthesia, Год журнала: 2024, Номер unknown

Опубликована: Дек. 1, 2024

Язык: Английский

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