Masui. The Japanese journal of anesthesiology
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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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To avoid perioperative cardiac complications and deterioration of renal function in chronic kidney disease (CKD), anesthesiologists are required to manage respiration and circulation properly. Three mechanisms are considered to worsen renal function during inappropriate mechanical ventilation; first, hypercapnia or hypoxemia, second, unstable systemic hemodynamic, and third, systemic inflammatory mediators derived from pulmonary biotrauma. Many circulatory problems are present in CKD patients, for example, hypertension, cardiac hypertrophy, cardiomyopathy, ischemic heart disease, arterial sclerotic valve disease, salt and water retention etc. ⋯ Appropriate hemodynamic monitoring, including direct arterial pressure, left ventricular preload, intravascular volume and cardiac output could be helpful for anesthesiologists to manage CKD patients safely. In the area of CKD and anesthesia, there is lack of evidence in respiratory and circulatory strategies. Prospective studies in these aspects are required in the future.
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The concept and the definition of CKD proposed by The National Kidney Foundation (USA) have been there for 10 years. The Japanese Society of Nephrology also has conducted the education and the spread of CKD. Consequently, in 2009 the newly introduced dialysis patients reached the ceiling in number in Japan. Definition, diagnosis, grading and the treatment of CKD published in 2012 by The Japanese Society of Nephrology were reviewed in this article.
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Historical Article
[The first labor analgesia with drug was performed in late Meiji Period (1868-1912). Hypnosis also attracted attention as a method of labor analgesia in mid-Meiji Period].
Ether or chloroform, was in use for ambulatory surgery after 1861 in Japan. An inhalational anesthetic, especially chloroform, was administered for cesarean section in early Meiji Period (from 1868) up to 1897. ⋯ However, it is uncertain whether inhalational anesthetic had been utilized for vaginal deliveries before 1903. There is evidence that hypnosis had attracted attention as a method of labor analgesia around that time.
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Increasing number of patients are suffering from chronic kidney disease (CKD). Accordingly, the opportunity of anesthesiologists taking care of patients with CKD will be expected to increase. This issue highlights the anesthetic management of patients with CKD, so that every anesthesiologist may refresh knowledge and clinical skills to manage patients with CKD.