Masui. The Japanese journal of anesthesiology
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Meta Analysis
[Efficacy of videolaryngoscopes for nasotracheal intubation: a meta-analysis of randomized controlled trials].
Increased evidence indicates that the videolaryngoscope is useful for nasotracheal intubation. The aim of this meta-analysis is to assess the efficacy of videolaryngoscopes (Glidescope, Airtraq and Pentax-AWS) in nasotracheal intubations, comparing with that of Macintosh laryngoscopy. ⋯ Our meta-analysis showed that the videolaryngoscope has an advantage over Macintosh laryngoscope in nasotracheal intubations.
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Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. ⋯ Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.
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Chronic kidney disease (CKD) often accompanies cardiovascular complications, causing postoperative morbidity and even mortality. Since fluid and electrolyte homeostasis is deregulated in CKD patients, fluid therapy itself may cause postoperative morbidity. Recent studies have shown that forced diuresis through fluid overload offers no renoprotective effect and instead has harmful consequences. ⋯ The regulation of renal function through the endocrine system (i.e., renin-angiotensin-aldosterone and vasopressin) is a key target for protecting the kidney in CKD. The recent development of a receptor blocker targeting these endocrine systems may be beneficial for correcting the fluid balance caused by excess intraoperative fluid therapy. The main issue for fluid therapy in surgical CKD patients may not be the quantity of fluid, but rational intervention affecting the endocrine system.
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In Japan, the number of patients with chronic kidney disease (CKD) has increased. Hence, the opportunities for intensive care management of patients with CKD have also increased. Acute kidney injury (AKI) easily develops following CKD, and conversely, it can be a risk factor for CKD. ⋯ While "goal-directed" hemodynamic management, which targets particular hemodynamic variables, might be useful in CKD patients, there is no evidence to prove its efficacy. Renal Replacement Therapy (RRT) is usually started after metabolic acidosis, hyperkalemia, ingestion of dialyzable toxin, volume overload and uremia have occurred. However, it is not clear whether continuous or intermittent RRT is beneficial in these patients.
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Review
[Perioperative management after non-cardiac surgery in patients with chronic kidney disease].
The number of patients with chronic kidney disease (CKD) continues to increase all over the world for the past ten years. It follows that we have more CKD patients with various complications who need perioperative management in Japan. ⋯ Safe comprehensive anesthetic management is required in order not to aggravate the preoperative CKD. In this review, we will take up some recent topics and novel concept in association with noncardiac surgery for the perioperative management of CKD patients.