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Pandey S, Borkar S, Monteiro JM, Mathew S, Vernekar D, Barreto O, Arun Gopinathan P, Pillai VG, Kishan AV, Joute IL. Comparative Study of 0.5% Bupivacaine, 0.5% Ropivacaine, and 0.75% Ropivacaine With Fentanyl as a Continuous Intraoperative Epidural Infusion on Post-operative Analgesia. Cureus 2024; 16:e59477. [PMID: 38827008 PMCID: PMC11142727 DOI: 10.7759/cureus.59477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Persistent postoperative pain leads to impaired patient recovery and delays in discharge of patients. The aim was to compare the efficacy of 0.5% bupivacaine to two varying concentrations of ropivacaine, specifically 0.5% and 0.75%, along with fentanyl as a continuous epidural infusion in providing adequate pain relief for patients subjected to infraumbilical surgeries. Materials and methods A prospective randomized comparative study was carried out on 150 patients and was divided into three groups, namely group B, group R, and group RP. Group B indicates (0.5% bupivacaine), group R means (0.5% ropivacaine), and finally, group RP means (0.75% ropivacaine); the three groups had 50 patients each. Group B was administered an epidural infusion of bupivacaine at a concentration of 0.5%, group R was given 0.5% ropivacaine, and group RP was treated with 0.75% ropivacaine; all three groups included 40 mcg fentanyl. The duration of the motor and sensory blockade and the time needed for the first rescue analgesia after the stoppage of epidural infusion were assessed in all three groups. The data were statistically analyzed using the ANOVA, "post hoc Tukey," and chi-square tests. Results Comparison of the duration of motor and sensory blockade among all three groups showed that group RP (0.75% ropivacaine with 2 mcg/cc fentanyl) had the longest duration of 328.8 and 406 minutes, and the difference was statistically significant (p < 0.001). Comparison of the time of stoppage of epidural infusion to the requirement of first rescue analgesia showed that the group that received 0.75% ropivacaine with 40 mcg fentanyl had the highest value of 258.6 minutes and was statistically significant (p < 0.001). Conclusion Epidural intraoperative infusion of 0.75% ropivacaine with fentanyl offers better postoperative pain relief as compared to both 0.5% bupivacaine and 0.5% ropivacaine with fentanyl.
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Affiliation(s)
- Shashaank Pandey
- Department of Anesthesiology, KMC Digital Hospital, Maharajganj, IND
| | - Sharmila Borkar
- Department of Anesthesiology, Goa Medical College, Bambolim, IND
| | | | - Sherin Mathew
- Department of Anesthesiology, Goa Medical College, Bambolim, IND
| | - Divya Vernekar
- Department of Anesthesiology, Goa Medical College, Bambolim, IND
| | | | - Pillai Arun Gopinathan
- Department of Maxillofacial Surgery and Diagnostic Sciences, College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | - A Vijeth Kishan
- Department of Anesthesiology, Goa Medical College, Bambolim, IND
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Yacout AG, ELHoshy HS. Continuous femoral nerve block enhances outcome of spinal anaesthesia in preventing perioperative cardiac complications in patients with cardiac risk. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2175896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- A G Yacout
- Lecturer of Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - H S ELHoshy
- Lecturer of Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Echeverry-Marín PC, Pérez-Pradilla AC, Reyes-Escobar B, Pereira-Ospina RDP, Quiroga-Carrillo M. Concordance between the loss of resistance technique and ultrasound in measuring the distance from the skin to the epidural space in pediatric patients: Observational study. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2020. [DOI: 10.5554/22562087.e935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: The use of ultrasound in regional anesthesia has become a standard technique to improve nerve block accuracy and reduce associated complications. The literature reports a good correlation between the distance from the skin to the dura mater or the ligamentum flavum measured on ultrasound and the conventional technique of “loss of resistance”. Latin American populations have not been included in the studies conducted so far but, because of differences in physical build, it is important to determine whether this correlation is maintained in the various populations. This paper offers new information about the role of ultrasound in determining the distance to the ligamentum flavum and recognizing the proximity of the dura mater to avoid accidental puncture of this structure in Latin American populations.
Objective: To determine correlation and concordance in estimating the distance from the skin to the epidural space between the loss of resistance technique and ultrasound measurement.
Methodology: Observational study conducted in 52 pediatric patients who received general anesthesia plus peridural analgesia for acute perioperative pain management between July 2014 and November 2015 to assess correlation and concordance between loss of resistance and ultrasound measurement of distance to the epidural space.
Results: There is a correlation between distances measured using the two techniques, which appears to be higher as patient age increases. As for concordance, the study found that 0.43 cm should be added to the ultrasound measurement to achieve agreement with the distance obtained using the loss of resistance technique; however, the interval between the two measurements is 1.15 cm.
Conclusions: A correlation was found between the measurement taken from the skin to the peridural space using ultrasound and the measurement obtained with the traditional needle puncture and loss of resistance technique. Although concordance was not as expected and the distance measured with ultrasound may be smaller than the real measurement with the needle, ultrasound offers good guidance regarding proximity to the peridural space.
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Abstract
PURPOSE OF REVIEW There has been a recent surge of interest in clinical applications of ultrasound, which has revolutionized acute pain management. This review is to summarize the current status of ultrasound utilization in neuraxial anesthesia, the most common type of regional anesthesia. RECENT FINDINGS Ultrasound-assisted and ultrasound-guided neuraxial anesthesia has improved clinical accuracy and patient safety through landmark identification including proper vertebral level and midline, as well as via measurements on neuraxial space. Direct needle or catheter visualization during the entire procedure has not yet been achieved consistently. The recent introduction of ultrasound into neural anesthesia has clinical performance benefits and patient safety implications, with documented improvement on overall efficacy with higher first attempt success rate as well as less needle pass. More controlled studies are needed for the overall impact of ultrasonography in neuraxial anesthesia in obstetric and non-obstetric patients.
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Affiliation(s)
- Jinlei Li
- Department of Anesthesiology, Yale University, New Haven, CT, USA.
| | - Ramya Krishna
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Yang Zhang
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, USA
| | - David Lam
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale University, New Haven, CT, USA
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McCullagh M, Slattery D. Medication related litigation in Ireland: A 6-year review. Br J Clin Pharmacol 2019; 85:2155-2162. [PMID: 31219195 DOI: 10.1111/bcp.14035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 11/27/2022] Open
Abstract
AIMS The primary aims of the study were to identify those medications most frequently associated with clinical litigation in Ireland and to quantify the cost of such litigation. Secondary aims were to identify where in the medication-use process claims were most likely to arise, the medication incident types involved and the primary injury alleged. METHODS The National Incident Management System (NIMS) for incident and claims management was searched to identify all medication-related claims finalised from 2011 to 2016 (inclusive). The physical case files were obtained and additional data not available on NIMS was extracted in order to build a detailed picture of the incident and subsequent claim. RESULTS The search identified 79 relevant claims, of which 48 closed with a payment to the plaintiff. These 48 claims involved 54 medications. Medication groups identified included general anaesthetics (n = 7), opioids (n = 6), penicillins, antithrombotics and local anaesthetics (all n = 5). The errors alleged occurred exclusively at the administration (58%) and prescribing (42%) stages of the medication-use process. Medication incident types included wrong dose/strength (n = 17), wrong drug (n = 7) and adverse drug reaction (n = 6). The most commonly pleaded primary injuries were allergic reaction (n = 9), deterioration in clinical status (n = 9) and post-traumatic stress disorder (n = 8). The median total cost of these claims was €60 991, including median damages of €33 858. CONCLUSIONS This study links data on medication incidents, actual harm to patients and litigation costs. Thus, it presents a comprehensive picture of the consequences of medication error.
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Luctkar-Flude M, Wilson RA, Sears K, Pulling C, Hopkins-Rosseel D, Jaeger M. Development and Evaluation of an Epidural Analgesia Workshop for Senior Nursing Students. J Nurs Educ 2018; 57:359-365. [PMID: 29863737 DOI: 10.3928/01484834-20180522-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most prelicensure nursing students receive little to no training in providing care for patients who receive epidural analgesia, despite exposure in clinical settings and the potential for devastating adverse effects. To develop and pilot an epidural workshop for senior nursing students using standardized patients (SPs), and to evaluate feasibility and learner outcomes. METHOD A 4-hour epidural workshop consisted of a large group lecture and demonstration, small-group practice scenarios, and individual learner evaluation with SPs. Learning outcomes were evaluated using a performance checklist and critical thinking rubric, and pre- and posttests. RESULTS Participants scored well on the performance-based evaluation (mean score of 86% items performed correctly) and rated the workshop highly. However, learners and instructors made several recommendations for improving the learning module for future sessions. CONCLUSION This pilot project demonstrated that an epidural analgesia workshop using SPs is feasible and results in positive learning outcomes and high satisfaction with senior nursing students. [J Nurs Educ. 2018;57(6):359-365.].
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Jiang H, Shi B, Xu S. An anatomical study of lumbar epidural catheterization. BMC Anesthesiol 2015; 15:94. [PMID: 26099935 PMCID: PMC4476177 DOI: 10.1186/s12871-015-0069-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We herein provide an analysis of lumbar epidural catheterization, which outlines a detailed anatomical description of the epidural anatomy, and may improve the success rate of neuraxial cannulation. METHODS Lumbar epidural catheters were placed in 50 adult embalmed cadavers. After catheterization, the lumbar dura and connecting structures between the epidural space and the vertebral body were separated. The positional relationship between the catheter and the posterior epidural space were observed and photographed. RESULTS Amongst the 50 specimens, the epidural catheter curled into a circle in three cases, entered the intervertebral foramen in two cases, and caused epidural venous damage in five cases. CONCLUSIONS Meningo-vertebral ligaments exist in the posterior epidural space and connect to the venous plexus, which may contribute to epidural catheter failure, uneven distribution of anaesthesia and epidural hemorrhage. Our study provides anaesthesiologists with a better understanding of the anatomy and may mitigate complications of lumbar epidural catheter placement.
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Affiliation(s)
- Huanwei Jiang
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China. .,Department of Anesthesiology, Shenzhen Nanshan District Maternity & Child Healthcare Hospita, Shenzhen, China.
| | - Benchao Shi
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Shiyuan Xu
- Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
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Parate LH, Manjrekar SP, Anandaswamy TC, Manjunath B. The effect of addition of low dose fentanyl to epidural bupivacaine (0.5%) in patients undergoing elective caesarean section: A randomized, parallel group, double blind, placebo controlled study. J Postgrad Med 2015; 61:27-31. [PMID: 25511214 PMCID: PMC4944362 DOI: 10.4103/0022-3859.147032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/10/2014] [Accepted: 08/31/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Opioids have synergistic action with local anesthetics which may alter characteristics of epidural block. Giving opioids to mother before delivery of baby is still fully not accepted with some fearing risk of neonatal depression. AIMS Our primary aim was to evaluate the analgesic effect of addition of 50 μg fentanyl to epidural 0.5% bupivacaine in patients undergoing elective caesarean section using visual analog scale. The secondary aim was to assess onset of analgesia, volume of drug required to achieve T6 level, grade and duration of motor block and Apgar score. MATERIALS AND METHODS In this prospective, randomized, double blind, placebo controlled study 64 patients scheduled for elective caesarean section under epidural anesthesia were randomly divided into two groups of 32 each. The fentanyl group received 1 ml of 50 μg fentanyl and the saline group received 1 ml of normal saline mixed with 10 ml of 0.5% bupivacaine for epidural anesthesia. VAS score, time to achieve T6 level, dose of bupivacaine, intraoperative analgesic consumption and duration of analgesia, grade and duration of motor block and any adverse maternal and neonatal effects were noted. STATISTICAL ANALYSIS Data was analyzed using Students t test, chi-square test and Mann-Whitney U-test. The values of P<0.05 were considered statistically significant. RESULTS Fentanyl improved the VAS score significantly (1.6±1.32) compared to the saline group (3.77±1.0, P<0.0001). It also reduced the intraoperaitve analgesic supplementation compared to the saline group. (P=0.031). The postoperative duration of analgesia was prolonged in the fentanyl group (275.80±13.61 min) compared to the saline group (191.47±12.16 min, P<0.0001). The other characteristics of epidural block were unaltered. CONCLUSION Addition of 50 μg fentanyl to epidural 0.5% bupivacaine significantly reduces the VAS score. It also reduces intra-operative analgesia supplementation and prolongs the duration of postoperative analgesia without altering the other characteristics of block. The neonatal outcome is not affected with addition of fentanyl before delivery of baby.
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MESH Headings
- Adult
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/adverse effects
- Anesthesia, Epidural
- Anesthesia, Obstetrical
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/adverse effects
- Bupivacaine/administration & dosage
- Bupivacaine/adverse effects
- Cesarean Section
- Dose-Response Relationship, Drug
- Double-Blind Method
- Female
- Fentanyl/administration & dosage
- Humans
- Infant, Newborn
- Injections, Epidural
- Pain Measurement
- Pain, Postoperative/drug therapy
- Pregnancy
- Prospective Studies
- Treatment Outcome
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Affiliation(s)
- LH Parate
- Department of Anaesthesia, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - SP Manjrekar
- Department of Anaesthesia, Indira Gandhi Medical College, Nagpur, Maharashtra, India
| | - TC Anandaswamy
- Department of Anaesthesia, MS Ramaiah Medical College, Bangalore, Karnataka, India
| | - B Manjunath
- Department of Community Medicine, MS Ramaiah Medical College, Bangalore, Karnataka, India
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Butcher M, George RT, Ip J, Campbell JP, Yentis SM. Identification of the midline by obese and non-obese women during late pregnancy. Anaesthesia 2014; 69:1351-4. [DOI: 10.1111/anae.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- M. Butcher
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - R. T. George
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - J. Ip
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - J. P. Campbell
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
| | - S. M. Yentis
- Department of Anaesthesia; Chelsea and Westminster Hospital; London UK
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Fahy AS, Jakub JW, Dy BM, Eldin NS, Harmsen S, Sviggum H, Boughey JC. Paravertebral blocks in patients undergoing mastectomy with or without immediate reconstruction provides improved pain control and decreased postoperative nausea and vomiting. Ann Surg Oncol 2014; 21:3284-9. [PMID: 25034821 DOI: 10.1245/s10434-014-3923-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Mastectomy is associated with postoperative nausea and pain. We evaluated whether paravertebral block (PVB) use altered opioid use, antiemetic use, and length of stay in patients undergoing mastectomy. METHODS We performed a retrospective cohort analysis of all patients who underwent mastectomy with or without PVB from 2008 to 2010. Patient demographics, operative procedure, intraoperative medications, postoperative opioid and antiemetic use, and length of stay were reviewed. Statistical analysis included univariable and multivariable analysis. RESULTS A total of 605 patients were identified, of whom 526 patients were evaluable. A total of 294 patients underwent mastectomy without PVB (132 bilateral), and 232 patients underwent mastectomy with PVB (148 bilateral). Immediate reconstruction was performed in 203 (39 %) patients. Need for any postoperative antiemetic was less frequent in the PVB group (39 vs. 57 %, p < 0.0001). Day of surgery opioid use was lower in the PVB group than the non-PVB group (mean ± SD 40.1 ± 15.2 vs. 47.6 ± 17.7 morphine equivalents, p < 0.0001). Decreased opioid use was seen in unilateral mastectomy without reconstruction and bilateral mastectomy with and without immediate reconstruction. The proportion of patients discharged within 36 h of surgery was significantly higher in the PVB group (55 vs. 42 %, p = 0.0031). On multivariable analysis controlling for year of surgery, patient age and surgeon, PVB use affected antiemetic use and opioid use but not hospital length of stay. CONCLUSIONS PVB results in decreased opioid use and decreased need for postoperative antiemetic medication in patients undergoing mastectomy. The greatest benefit is seen in patients undergoing bilateral mastectomy with immediate breast reconstruction.
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Autran Gomez AM, Clarke C, Smith D, Yutkin V, Alzahrani A, Izawa JI. Is postoperative epidural analgesia better than patient-controlled analgesia for radical cystectomy? JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813500954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to evaluate postoperative epidural analgesia (EPA) and intravenous patient-controlled analgesia (PCA) in terms of morbidity and mortality in patients undergoing radical cystectomy for bladder cancer. Methods: A retrospective study on patients undergoing radical cystectomy for clinical Tis-4N0M0 urothelial carcinoma of the bladder was performed. Patients were separated into two groups: primary EPA or PCA for postoperative analgesia. The surgical complication severity was determined according to the Clavien system. Mann-Whitney U tests, χ2 with Yates’ correction, or Fisher’s exact test were used. Predictive risk factors were explored using univariable and multivariable Cox regression models. Results: Of the 274 patients studied, 209 (76%) received EPA and 65 (24%) had PCA. Baseline balance was observed. Similar complication rates were observed between the EPA (36%) and PCA (34%) ( p=0.382). Patients greater than 70 years of age had more complications (35% vs 21%, p=0.002). PCA patients had higher rates of high-grade complications compared with EPA patients [40% vs 20% ( p=0.0007)]. Only age at time of surgery ( p=0.032) was associated with complications. Patients with pulmonary disease had a higher risk of complications ( p=0.001). EPA or PCA were not predictors for overall survival. Conclusions: There does not appear to be a significant difference in terms of morbidity or mortality between EPA and PCA following radical cystectomy (RC). Rare, catastrophic complications specific to EPA may occur. Standardized reporting of surgical complications is essential to compare studies and appropriately counsel patients.
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Affiliation(s)
| | - Colin Clarke
- Department of Anesthesia, Western University, Canada
| | - David Smith
- Department of Anesthesia, Western University, Canada
| | | | | | - Jonathan I Izawa
- Departments of Surgery, Oncology and Pathology, Western University, Canada
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Serrano AB, Asuero MS. [Is postoperative epidural analgesia worthwhile actually?]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:63-67. [PMID: 22935763 DOI: 10.1016/j.redar.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
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Chenitz KB, Lane-Fall MB. Decreased urine output and acute kidney injury in the postanesthesia care unit. Anesthesiol Clin 2012; 30:513-26. [PMID: 22989592 DOI: 10.1016/j.anclin.2012.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Decreased urine output and acute kidney injury (also known as acute renal failure) are among the most important complications that may develop in the postanesthetic period. In this article, the authors present definitions of decreased urine output, oliguria, and acute kidney injury. They review the epidemiology, pathophysiology, and prevention of postoperative acute kidney injury. Finally, the article offers approaches to diagnosis and management of the postsurgical patient with decreased urine output or acute kidney injury.
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Affiliation(s)
- Kara Beth Chenitz
- Renal, Electrolyte and Hypertension Division, Department of Internal Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 1 Founders Building, Philadelphia, PA 19104, USA
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