Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2004
ReviewAnaesthetic considerations for laparoscopic surgery in neonates and infants: a practical review.
Minimally invasive surgery is being applied to an increasing number of neonates and infants undergoing abdominal surgeries. Knowledge of specific implications, patient's health status and pathophysiological changes induced by the surgery allow the anaesthesiologist to provide safe anaesthesia to these high-risk patients. This chapter describes the specific pathophysiological effects, peri-operative management, major complications and contraindications related to endoscopic procedures.
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Because oliguria is a bad prognostic sign in patients with acute renal failure (ARF), diuretics are often used to increase urine output in patients with or at risk of ARF. From a pathophysiological point of view there are several reasons to expect that loop diuretics also could have a beneficial effect on renal function. However, clinical trials on the prophylactic use of loop diuretics rather point to a deleterious effect on parameters of kidney function. ⋯ On the other hand, such an effect cannot be excluded because the available trials lack statistical power. Possible explanations for the absence of a renoprotective effect are discussed. The evidence for a renoprotective effect of mannitol is restricted to the setting of renal transplantation.
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Best Pract Res Clin Anaesthesiol · Mar 2004
ReviewClinical and laboratory diagnosis of acute renal failure.
Acute renal failure (ARF) is defined in general terms as an abrupt decrease in renal function sufficient enough to result in retention of nitrogenous waste and disrupt fluid and electrolyte homeostasis. There is no consensus regarding a quantifiable definition of ARF. Prompt evaluation of ARF is vital because ARF can be the end result of diverse processes which can often be reversed or attenuated through therapy directed at the underlying condition. ⋯ When this evaluation fails to yield a diagnosis, further testing may be required to evaluate intravascular volume status or diagnose a systemic disorder or glomerular cause of ARF. Response to therapeutic trials may provide a diagnosis. When a diagnosis cannot be made with reasonable certainty through this evaluation renal biopsy should be considered.
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Best Pract Res Clin Anaesthesiol · Mar 2004
ReviewPathophysiology of ischaemic acute renal failure.
This chapter summarizes the pathophysiology of ischaemic acute renal failure from both the experimental and clinical points of view. Traditionally, the abrupt fall in glomerular filtration rate (GFR) is thought to be due to an interplay of haemodynamic and tubular abnormalities. The intrarenal haemodynamic alterations include renal vasoconstriction, leukocyte-endothelium interactions and loss of blood flow and GFR autoregulation. ⋯ During this recovery phase some of the damaged cells undergo de-differentiation--which is an important step in regeneration of the tubular epithelium. Recent evidence points to the possibility that infiltration of the kidney with bone-marrow-derived stem cells contributes to the repair process. The molecular mechanisms and the effect of growth factors are summarized.
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Best Pract Res Clin Anaesthesiol · Mar 2004
ReviewInfluence of renal replacement therapy on pharmacokinetics in critically ill patients.
Critical illness has a great impact on many pharmacokinetic parameters. An increased volume of distribution often results in drug underdosing, whereas organ impairment may lead to drug accumulation and overdosing. ⋯ Mechanisms of drug removal during RRT are reviewed together with methods for measuring or estimating RRT drug clearances. Approaches for drug-dosing adjustments are suggested and, at the end, the pharmacological principles for antibiotic prescription in the critically ill are discussed.