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Anesthesia and renal disease

机译：麻醉和肾脏疾病

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Purpose of review: To present and interpret the relevant research (Jan 2001-Feb 2002) which has the most important implications for clinical anesthesiology as regards the prevention of perioperative renal dysfunction and the anesthetic management of patients with renal disease. Recent findings: Prolonged sevoflurane anesthesia with fresh gas flow less than 1 l min-1 is unlikely to lead to clinically significant renal injury. When used as maintenance agents for patients undergoing coronary artery bypass grafting, sevoflurane anesthesia at a fresh gas flow of 3 l min-1, isoflurane and propofol are associated with similar rates of postoperative renal dysfunction. Less compound A is produced with smaller soda lime containers. High flow sevoflurane anesthesia (fresh gas flow of 4-6 l min-1) in combination with perioperative ketorolac is unlikely to lead to renal injury. Chronic treatment with angiotensin-converting enzyme inhibitors is associated with an increased incidence of postoperative renal impairment in patients undergoing elective aortic surgery. Thoracic epidural anesthesia and postoperative analgesia are associated with a decreased incidence of renal failure in patients undergoing coronary artery bypass grafting. Compared with open surgical repair, endovascular repair of aortic aneurysm is associated with less renal injury. Summary: Sevoflurane anesthesia at low or high fresh gas flow rates is probably no more injurious to the kidneys than other commonly used maintenance agents. Chronic angiotensin-converting enzyme inhibition may increase perioperative renal dysfunction. The use of thoracic epidural anesthesia and analgesia may reduce the incidence of postoperative renal failure.
机译：审查目的：介绍和解释相关的研究（2001年1月至2002年2月），该研究对临床麻醉学的预防，围手术期肾功能不全和肾病患者的麻醉管理具有最重要的意义。最新发现：长时间使用新鲜气体流量小于1 l min -1 的七氟醚麻醉不太可能导致临床上严重的肾脏损伤。当用作接受冠状动脉搭桥术的患者的维持剂时，在3 l min -1 的新鲜气流下进行七氟醚麻醉，异氟烷和丙泊酚与术后肾功能异常的发生率相似。用较小的钠钙容器生产的化合物A较少。高流量七氟醚麻醉（新鲜气体流量为4-6 l min -1 ）与围手术期酮咯酸相结合不太可能导致肾脏损伤。接受血管紧张素转换酶抑制剂的慢性治疗与接受选择性主动脉手术的患者术后肾功能损害的发生率增加相关。胸腔硬膜外麻醉和术后镇痛与冠状动脉搭桥术患者肾功能衰竭的发生率降低有关。与开放式手术修复相比，主动脉瘤的血管内修复与较少的肾脏损伤相关。简介：在低或高新鲜气体流速下进行七氟醚麻醉可能不会比其他常用的维持剂对肾脏造成更大的伤害。长期抑制血管紧张素转换酶可能会增加围手术期肾功能不全。胸腔硬膜外麻醉和镇痛可以减少术后肾功能衰竭的发生。

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