THIS PRESENTATION DISCUSSES IN BRIEF THE VARIOUS EFFECT OF ANAESTHESIA AND SURGERY ON RENAL FUNCTIONS. IT ALSO DISCUSSED THE PROTECCTIVE EFFECTS OF ANAESTHETIC AGENTS ON KIDNEY DURING THE PERIOPERATIVE PERIOD,
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Scalp block is simple and easy to perform. It has the advantages of minimizing cardiovascular effects and decreasing intraoperative analgesia requirements.
New GCS, the GCS-P was adopted in 2018 by the same person who proposed GCS. It gives better prognosticate outcomes compared to GCS.
Neuromuscular monitoring, also known as train of four monitoring, is a technique used during recovery from the application of general anesthesia to objectively determine how well a patient's muscles are able to function. It involves the application of electrical stimulation to nerves and recording of muscle response using, for example, an acceleromyograph. Neuromuscular monitoring is typically used when neuromuscular-blocking drugs have been part of the general anesthesia and the doctor wishes to avoid postoperative residual curarization (PORC) in the patient, that is, the residual paralysis of muscles stemming from these drugs.
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
The number of drugs associated with adverse reactions involving the liver is extensive, but in clinical practice is dominated by alcohol, antibiotics, antiepileptic medications and acetaminophen.
Complementary (herbal) medicines contribute to Liver Dysfuntion.
There are two distinct goals of drug therapy in CHF.
Relief of congestion/ low cardiac output symptoms and restoration of cardiac performance.
Ionotropic agents, Vasodilators, Diuretics, BETA Blockers.
Arrest/reversal of disease progression and prolongation of survival.
ACE inhibitors, ARBs, Beta Blockers, Aldosterone Antagonists.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. INTRODUCTION
• Anaesthesia and surgical stress can affect renal
function and body fluid regulation indirectly as
well as directly.
• The indirect effects, through influences on
haemodynamics, sympathetic activity and
humoral regulation, are more pronounced than
the direct ones.
• The direct effects of anaesthesia which are dose-
and agent-dependent include effects on renal
autoregulation, tubular transport of sodium and
organic acids and alteration in the effect of
ADH.
3. • Normal renal function appears to be regulated
by a balance between intrinsic autoregulation,
tubuloglomerular balance, hormonal and
neuronal influences.
• A comprehensive understanding of anesthetic
drugs and their effects on renal function remains
fundamental to the success of any surgery.
5. Renal Circulation
• Arterial supply:- Renal A. (br of Abdominal aorta)
• Venous drainage:- Renal vein into IVC.
• Both the kidneys weight around 0.4% of body
weight, but the combined blood flow accounts for
20-25% of total cardiac output (CO).
• 80% of renal blood flow goes to cortical nephrons.
10-15% goes to juxtamedullary nephrons.
• Autoregulation of renal blood flow occurs between
MAP of 80 and 180 mm Hg.
6. • Clearence:- volume of blood completely cleared
of a substance per unit of time.
• Renal Plasma Flow (RPF):- measured by p-
aminohippurate (PAH) clearance
RPF = clearence of PAH =
- [PAH]U = urinary concentration of PAH
- [PAH]P = plasma PAH concentration
• Renal Blood Flow (RBF)=
• Normally, RPF = 660mL/min and RBF = 1200mL/min
7. • Glomerular Filtration Rate (GFR):- Volume of fluid
filtered from the glomerular capillaries into
bowman’s capsule per unit time.
• Calculated using inulin or creatinine clearence.
[Creatinine]U:- creatinine concentration urine.
[Creatinine]P:- creatinine concentration plasma.
- Normal:- 120 ± 25 ml/min (male), 95 ± 20 ml/min (female)
• Filtration Fraction = GFR/RPF
- Normally:- 20%
8. Volatile Anaesthetics And Renal Functions
• Volatile anesthetics cause a decrease in GFR by
decreasing renal perfusion pressure either by
decreasing systemic vascular resistance
(isoflurane or sevoflurane) or cardiac output
(halothane).
• This decrease in GFR is exacerbated by
hypovolemia and the release of catecholamines
and antidiuretic hormone as a response to
painful stimulation during surgery.
9. Inhalation Agents
AGENT PROPERTY EFFECT
Halothane Inorganic fluoride levels are less No Neprotoxicity
Isoflurane Inorganic fluoride levels are less No Neprotoxicity
Desflurane Inorganic fluoride levels are very less, highly
stable & resists degradation by soda-lime &
liver
No Neprotoxicity
Sevoflurane Inorganic fluoride levels are less but not stable
, degraded by soda-lime to compound A &
undergoes liver metabolism.
Compound A is
Neprotoxic
Enflurane Biotranformed to inorganic fluoride levels after
prolonged use (> 4hrs)
Nephrotoxic, after
prolonged use
Methoxyflurane Biotranformed to high inorganic fluoride levels Highly
nephrotoxic
11. • Sevoflurane :-
• Sevoflurane is degraded in basic carbon dioxide
absorbents (Barium Hydroxide and Soda lime)
into a vinyl ether called compound A.
• Compound A has been implicated to cause renal
injury through fluoride toxicity (animal studies).
• High intra-renal fluoride concentrations impair
the concentrating ability of the kidney and may
theoretically lead to non-oliguric renal failure.
12. • However, studies have failed to show a relevant
effect in clinical practice.
• It is considered safe even in patients with renal
impairment as long as prolonged low-flow
anesthesia is avoided. (Minimum flow ≥ 2
L/min)
14. • Methoxyflurane caused dose-dependent
abnormalities post-surgery.
• It causes vasopressin-resistant polyuria, serum
hyperosmolality, hypernatremia, increased
concentrations of serum urea nitrogen and
inorganic fluoride, and decreased urinary
potassium, sodium, osmolality, and urea nitrogen
concentrations.
• Therefore, clinically it is no longer used.
15. FLUORIDE INDUCED NEPHROTOXICITY
• Metabolism of sevoflurane, isoflurane,
methoxyflurane, enflurane and halothane results
in production of fluoride ions.
• Isoflurane: 20 MAC-hours of isoflurane could lead
to serum flouride levels above 50uM/L, however
no postoperative renal dysfunction was detected.
16. • Sevoflurane: around 7% of patients who receive
sevoflurane will have serum flouride levels
above 50uM. Yet, no clinically significant renal
dysfunction was detected.
• Methoxyfluane and enflurane might cause renal
dysfunction especially when associated with
hypovolemia, shock and renal vasoconstriction.
18. OPIOIDS AND RENAL FUNCTIONS
• Opioid are commonly used safely in anesthesia
and pain control in the perioperative period.
• They decrease renal blood flow, GFR and urine
output which is minimal and transient.
• Ramifentanyl pharmacokinetics are unaffected
by renal functions due to rapid ester hydrolysis.
• With the exception of morphine and meperidine,
significant accumulation of active metabolites do
not occur.
19. • The renal toxicity appears in the context of
inappropriate use:- either higher than needed
doses, in the presence of other toxins, chronic use
of opioids (accumulation of metabolites), deranged
renal functions or with pre-existing dehydration.
• The accumulation of morphine (morphine-6-
glucuronide) and meperidine (normeperidine) has
been reported to prolong respiratory depression in
patients with kidney failure.
• Increased level of normeperidine has been
associated with seizures.
21. INTRAVENOUS AGENTS AND RENAL
FUNCTIONS
• These exhibit minor effect on kidney when used
alone.
• Ketamine minimally effects and preserves renal
functions during haemorrhagic hypovolaemia. It
is associated with tachycardia, increased blood
pressure, and increased cardiac output; useful in
the shocked, unwell patient.
• Propofol can be safely used. Its long term
infusion use – ‘Propofol Infusion Syndrome’ is
associated with renal failure.
23. • Life-threatening condition characterised by
acute refractory bradycardia progressing to
asystole and one or more of:-
(1) metabolic acidosis.
(2) rhabdomyolysis or myoglobinuria.
(3) hyperlipidaemia.
(4) enlarged or fatty liver.
• Risk Factors:-
- >4mg/kg/hr (> 75µg/kg/min)for 48 hours; but
can occur at lower doses
- younger age.
- acute neurological injury.
26. MUSCLE RELAXANTS AND KIDNEYS
• Upon administering histamine releasing muscle
relaxants (mivacurium, atracurium,
succinylcholine, d-tubocurare), there is transient
fall in blood pressure, renal blood flow and
cardiac output.
• This hypotension has been attributed to histamine
release and autonomic ganglionic blockade.
27. • Based on clinical and experimental data, it
appears that muscle relaxants have only a modest
impact on RBF and no meaningful adverse
influence on postoperative Renal functions when
Blood Pressure and Cardiac Output are
adequately maintained.
29. COLLOIDS AND KIDNEY
• Albumin gives renoprotection which may be
explained by maintaining renal perfusion,
promoting proximal tubular integrity and
function, binding of endogenous toxins and
nephrotoxic drugs, and preventing oxidative
damage.
• Carbohydrate-based artificial colloids
hydroxyethyl starch (HES) and dextran were
frequently associated with acute kidney injury.
30. • The degradation products of HES and Dextran
cause direct tubular injury and plugging of
tubules.
• Renal failure following HES and dextran use is
more often reported when renal perfusion is
reduced or when pre-existing renal damage is
present.
32. DRUGS WITH ANTI-DOPAMINERGIC ACTIVITY
• Dopamine and fenoldopam (selective D1 agonist)
dilate afferent and efferent arterioles and
increase renal perfusion.
• Drugs like Metoclopramide, phenothiazines, and
droperidol may impair the renal response to
dopamine and may precipitate AKI (in
susceptible patients).
34. NSAIDS AND RENAL FUNCTIONS
• Renal synthesis of vasodilating prostaglandins
(PGD2, PGE2 and PGI2) is an important
protective mechanism during periods of systemic
hypotension and renal ischemia.
• Inhibition of prostaglandin synthesis by NSAIDs
impairs the renal autoregulation (the purpose of
which was to maintain renal blood flow during
systemic vasoconstriction eg In hypovolaemics).
• NSAIDs also cause acute interstitial nephritis.
36. ACE INHIBITORS AND ITS RENAL EFFECTS
• Angiotensin II causes generalized arterial
vasoconstriction and secondarily reduces RBF.
• Both afferent and efferent glomerular arterioles are
constricted, but because the efferent arteriole is
smaller, its resistance becomes greater than that of
afferent arteriole; GFR tends to be relatively
preserved.
• ACE inhibitors block the protective effects of
Angiotensin II and may result in reduction of GFR
during anaesthesia.
• These prevent the local action of bradykinins,
responsible for constriction of the efferent arteriole.
39. EFFECT OF POSITIVE PRESSURE
VENTILATION (PPV)
• Positive-pressure ventilation used during general
anesthesia can decrease venous return, cardiac
output, renal blood flow, and GFR.
• Decreased cardiac output leads to release of
catecholamines, ADH, renin, and angiotensin II
with the activation of the sympathoadrenal
system and resultant decrease in renal blood flow.
41. REGIONALANAESTHESIAAND RENAL
FUNCTIONS
• Spinal and epidural anaesthesia only slightly
decrease GFR and RBF in proportion to the
decrease in mean arterial pressure.
• The preexisting intravascular volume and the
quantity of intravenous fluids given strongly
influence the renal response to spinal and epidural
anaesthesia.
• There is also decreased diuresis and a marked fall in
sodium excretion.
• These trends are gradually reversed during
recovery.
43. EFFECTS OF SURGERY ON RENAL
FUNCTIONS
• Surgery influences renal functions by inducing
alterations in prerenal haemodynamics.
• Operative stress leads to an increase in
circulating catecholamines and angiotensin.
• Significant fluid shifts, excessive blood loss and
redistribution of third space may lead to a
prerenal oliguric state, increasing secretion of
vasopressin.
45. PNEUMOPERITONEUM AND ITS EFFECT
ON KIDNEY
• Pneumoperitoneum produced during laparoscopy
creates an abdominal compartment syndrome like
state.
• The increase in intra-abdominal pressure typically
produces oligouria (or anuria) that is proportional
to insufflation pressures.
• Mechanisms:- central venous compression (renal
vein and vena cava), renal parenchyma
compression, decreased cardiac output; and
increase in plasma level of renin, aldosterone and
ADH.
47. CARDIOPULMONARY BYPASS (CPB)
AND RENAL FUNCTIONS
• Initiation of CPB is associated with increase in
stress hormone and systemic inflammatory
response.
• Elevated levels of catecholamine, cortisol,
arginine vasopressin and angiotensin are
observed.
• These are influenced by depth of anaesthesia,
blood pressure and type of surgical repair.
48. • Multiple humoral systems are also activated
including complement, coagulation and
fibrinolysis.
• Also, increased amount of oxygen derived free
radicals are generated.
• These mediators can cause decreased renal
perfusion, direct tubular injury and renal
vasoconstriction.
49. WHAT ARE THE EFFECTS OF AORTIC
CROSS CLAMPING ON KIDNEYS?
50. CROSS CLAMPING OF AORTAAND ITS
RENAL EFFECTS
• Cross-clamping of the aorta is associated with
decreases in organ perfusion distal to occlusion
(spinal cord, kidneys, abdominal viscera, limbs).
• Clamping of abdominal aorta (suprarenal or
infrarenal) is associated with transient renal
insufficiency (Ischaemic perfusion injury).
• Cross-clamping of the thoracic aorta is associated
with severe decreases in renal blood flow,
glomerular filtration rate, and urine output.
51. • Mediators:- Prostaglandin imbalance, AT II,
Sympathetic nervous system, catechalamine .
• Renal Protective Measures:-
- Inj. Mannitol infusion (0.5 gm/kg) prior to
cross clamping
- Inj. Dopamine infusion (renal dose).
- Preserve renal blood flow:- Fenoldopam
infusion
- Maintainance of intravascular volume and
adequate cardiac functions.
53. EFFECTS OF POSITIONING ON KIDNEYS
• Open procedures on kidney are carried out in
‘kidney rest position’ – lateral flexed position.
• Dependant leg is flexed and the other is extended.
• Axillary roll – placed under dependant upper
chect.
• Operating table is extended to achieve maximal
seperation between iliac crest and costal margin.
• Kidney rest is elevated to raise the non dependant
iliac crest higher and increase surgical exposure.
54. • This position is associated with adverse
respiratory and circulatory effects.
• It can significantly decrease the venous return to
heart by compressing the inferior vena cava.
• Also, the venous pooling in the legs potentiates
anaesthesia induced vasodilation.
• Lithotomy position:- Elevation of leg drain blood
into central circulation acutely, mean BP and CO-
• Conversely, rapid lowering of legs from
lithotomy/trendelenburg acutely decreases
venouos return and can result in hypotension.
55. DOES ANAESTHESIA HAVE ANY RENAL
PROTECTION EFFECT AGAINST ISCHAEMIC
REPERFUSION (IR) INJURY?
56. • Renal ischemia/reperfusion (IR) injury is a
leading cause of peri-operative acute kidney
injury (AKI), which frequently complicates
major vascular, cardiac transplant and liver
surgeries.
• IR injury occurs due to oxidative stress,
inflammation, cellular necrosis and apoptosis.
• Researchers found that isoflurane and
sevoflurane provides preconditioning reno-
protective effects through anti-inflammatory,
anti-apoptotic actions and altering myocardial
calcium fluxes.
58. • Sodium thiopentone pretreatment reduced renal IR
injury induced by free radicals.
• Propofol protected cells from apoptosis by inhibiting
oxidative and mitochondrial stress; it also attenuates
tubular damage after reperfusion.
• Ketamine ameliorated the upregulation of
inflammatory pathways and reduction of metabolism
caused by hypoxia.
• Lidocaine (epidural analgesia) may provide
protection against IR injury by preventing miRNA
dysregulation.
59. SUMMARY
• The effects of anaesthetics on the kidney go beyond
a simple change in basal haemodynamics and
include, for some drugs, an alteration in the ability
for the kidney to autoregulate its blood flow and
glomerular filtration rate.
• Inhalational anaesthetics generally reduce
glomerular filtration rate and urine output, mainly
by extra-renal effects that are attenuated by pre-
operative hydration.
• Opioids, barbiturates and benzodiazepines also
reduce glomerular filtration rate and urine output.
60. • The effects of regional anaesthesia seem to be less
than those of general anaesthesia and are related
to changes in systemic haemodynamics.
• Mechanical ventilation decreases urine volume
and sodium excretion to an extent that depends
on the increase in intrathoracic pressure.
• Controlled hypotensive anesthesia, aortic cross-
clamping, and cardiopulmonary bypass represent
anticipated renal insults which should be
carefully managed.