Crit Care Resusc
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To review the role of drugs with potential benefit to renal function in critically ill patients. ⋯ The common factor in renal dysfunction and acute renal failure is tubular ischaemia. Prevention of this final common pathway is the chief goal of renal protection in critically ill patients. Despite the plethora of potentially beneficial drugs, volume loading and defence of renal perfusion pressure (and renal blood flow) with pressor agents appear to be the only reliable means of renal protection.
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A case is described of subarachnoid haemorrhage caused by vertebral artery dissection following general anaesthesia for laparoscopic cholecystectomy. It is postulated that the dissection may have been a result of neck manipulation during intubation or other movements whilst paralysed, or alternatively, due to intra-operative blood pressure changes occurring in a patient with a predisposition to arterial disruption. The case highlights the important symptom of neck pain in a patient with an intracranial catastrophe. Fortunately, despite a dramatic clinical presentation her recovery has been good.