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Related Concept Videos

General Anesthesia: Overview01:24

General Anesthesia: Overview

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Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
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Stages of General Anesthesia01:22

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Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
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Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

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Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
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Local Anesthetics: Pharmacokinetics01:13

Local Anesthetics: Pharmacokinetics

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The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
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Local Anesthetics: Adverse Effects01:12

Local Anesthetics: Adverse Effects

758
While local anesthetics are generally safe and well-tolerated, they can occasionally cause adverse effects that vary in severity. Local anesthetics can induce toxicity at two distinct levels. They can either produce local effects through direct contact with the neural elements or be absorbed into the bloodstream from the injection site, leading to systemic effects.
Once absorbed into the systemic circulation, local anesthetics can affect the organs that depend on the functioning of sodium...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

271
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Technical Refinement of a Bilateral Renal Ischemia-Reperfusion Mouse Model for Acute Kidney Injury Research
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General Anesthetic Agents and Renal Function after Nephrectomy.

Ho-Jin Lee1, Jinyoung Bae2, Yongsuk Kwon3

  • 1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea.

Journal of Clinical Medicine
|September 27, 2019
PubMed
Summary

Propofol anesthesia may reduce acute kidney injury and improve long-term kidney function after nephrectomy compared to sevoflurane or desflurane. Further research is needed to confirm these findings due to study limitations.

Keywords:
acute kidney injurychronic kidney diseasedesfluranenephrectomypropofolsevoflurane

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Area of Science:

  • Nephrology
  • Anesthesiology
  • Surgical Outcomes

Background:

  • The impact of anesthetic agents on kidney outcomes post-nephrectomy remains largely unexamined.
  • Understanding anesthetic choices' role in preventing acute kidney injury (AKI) and chronic kidney disease (CKD) is crucial for renal preservation.

Purpose of the Study:

  • To evaluate the association between different general anesthetic agents (propofol, sevoflurane, desflurane) and the risk of AKI and long-term renal dysfunction after nephrectomy.
  • To compare postoperative AKI, new-onset CKD, and CKD upstaging across anesthetic groups.

Main Methods:

  • Retrospective review of 1087 partial or radical nephrectomy cases.
  • Comparison of outcomes between propofol, sevoflurane, and desflurane groups.
  • Four propensity score analyses were conducted to control for confounding factors, with outcomes assessed before and after matching. Kaplan-Meier survival analysis was used for renal survival up to 36 months.

Main Results:

  • Propofol was associated with significantly lower incidence of AKI and CKD upstaging compared to sevoflurane and desflurane.
  • Propofol demonstrated better three-year renal survival and a lower incidence of new-onset CKD compared to sevoflurane post-nephrectomy after matching.
  • No significant differences were observed between sevoflurane and desflurane. Subgroup analysis for partial nephrectomy showed differences only in CKD upstaging.

Conclusions:

  • Propofol may be a preferable anesthetic agent over volatile agents like sevoflurane and desflurane for nephrectomy to reduce postoperative renal dysfunction.
  • The retrospective nature of the study and inconsistent subgroup findings necessitate cautious interpretation and further investigation.