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Jung CW, Bae YC. Perioperative management of facial reconstruction surgery in patients with end-stage renal disease undergoing dialysis. Arch Craniofac Surg 2024; 25:71-76. [PMID: 38742333 DOI: 10.7181/acfs.2024.00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/19/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The rising incidence of dialysis-dependent end-stage renal disease (ESRD) has underscored the need for collaboration between plastic surgeons and nephrologists, particularly concerning preoperative and postoperative management for facial reconstruction. This collaboration is essential due to a scarcity of comprehensive information in this domain. METHODS A study initiated in January 2015 involved 10 ESRD cases on dialysis undergoing Mohs micrographic surgery for facial skin cancer, followed by reconstructive surgery under general anesthesia. To ensure surgical safety, rigorous measures were enacted, encompassing laboratory testing, nephrology consultations, and preoperative dialysis admission. Throughout surgery, meticulous control was exercised over vital signs, electrolytes, bleeding risk, and pain management (excluding nonsteroidal anti-inflammatory drugs). Postoperative assessments included monitoring flap integrity, hematoma formation, infection, and cardiovascular risk through plasma creatinine levels. RESULTS Adherence to the proposed guidelines yielded a notable absence of postoperative wound complications. Postoperative plasma creatinine levels exhibited an average decrease of 1.10 mg/dL compared to preoperative levels, indicating improved renal function. Importantly, no cardiopulmonary complications or 30-day mortality were observed. In ESRD patients, creatinine levels decreased significantly postoperatively compared to the preoperative levels (p< 0.05), indicating favorable outcomes. CONCLUSION The consistent application of guidelines for admission, anesthesia, and surgery yielded robust and stable outcomes across all patients. In particular, the findings support the importance of adjusting dialysis schedules. Despite the limited sample size in this study, these findings underscore the effectiveness of a collaborative and meticulous approach for plastic surgeons performing surgery on dialysis-dependent patients, ensuring successful outcomes.
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Affiliation(s)
- Chan Woo Jung
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yong Chan Bae
- Department of Plastic and Reconstructive Surgery, Pusan National University School of Medicine, Busan, Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Hong WK, Kim S, Gong HS. Fracture Management in Chronic Kidney Disease: Challenges and Considerations for Orthopedic Surgeons. Clin Orthop Surg 2024; 16:173-183. [PMID: 38562627 PMCID: PMC10973623 DOI: 10.4055/cios23244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/29/2023] [Accepted: 11/24/2023] [Indexed: 04/04/2024] Open
Abstract
Orthopedic surgeons treating fractures need to consider comorbidities, including chronic kidney disease (CKD), which affects millions worldwide. CKD patients are at elevated risk of fractures due to osteoporosis, especially in advanced stages. In addition, fractures in CKD patients pose challenges due to impaired bone healing and increased post-fracture complications including surgical site infection and nonunion. In this article, we will discuss factors that must be considered when treating fractures in CKD patients. Perioperative management includes careful adjustment of hemodialysis schedules, selection of anesthetic methods, and addressing bleeding tendencies. Tourniquet usage for fractures in limbs with arteriovenous fistulae should be cautious. Pain medication should be administered carefully, with opioids like hydromorphone preferred over nonsteroidal anti-inflammatory drugs. Medical management after fractures should address underlying factors and include physical rehabilitation to reduce the risk of subsequent fractures. A comprehensive approach to fracture management in CKD patients can improve outcomes.
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Affiliation(s)
- Wan Kee Hong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Yagi Y, Kubo Y, Hoshino K, Okada K, Hotta K, Shinohara N, Morimoto Y. Differences of cerebral oxygen saturation in dialysis patients: a comparison of three principals of near infrared spectroscopy. J Anesth 2023; 37:861-867. [PMID: 37646882 DOI: 10.1007/s00540-023-03245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE It has been reported that cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy is low in dialysis patients. We compared the rSO2 values of dialysis patients before living donor kidney transplantation and their donors as controls by using three spectroscopes that utilize different principals, the INVOS 5100C (spatially resolved spectroscopy), FORE-SIGHT ELITE (modified Beer-Lambert law) and tNIRS-1 (time-resolved spectroscopy). METHODS Before induction of anesthesia, the sensors of one of the three spectroscopes were placed on the forehead and rSO2 values were recorded followed by the same measurement using the other two spectroscopes. The primary objective was to compare the rSO2 values of the dialysis patients and controls using the three spectroscopes by the unpaired t test. Then we compared the rSO2 values among the spectroscopes in both dialysis patients and controls by one-way ANOVA. Finally, we examined the relations between the rSO2 values and the physiological values by using the Pearson correlation coefficient. RESULTS Fifteen pairs of dialysis patients and controls were studied. With the INVOS 5100 C, the values of the dialysis patients (59.7 ± 9.7% (mean ± standard deviation) were 13% lower than those of the controls (73.3 ± 6.9%) (P < 0.01). With the tNIRS-1, the values were 57.8 ± 4.8% in the dialysis patients and 63.3 ± 3.5% in the controls (P < 0.01). Almost no differences were observed with the FORE-SIGHT ELITE (71.6 ± 4.9% [dialysis patients] vs. 70.8 ± 4.3% [Controls]) (P = 0.62). Among the spectroscopes, the values were significantly different in both dialysis patients and controls. For the INVOS 5100C and tNIRS-1, correlation coefficients between rSO2 values and blood Hb and serum Alb were more than 0.5. CONCLUSIONS The rSO2 values for comparisons between the dialysis patients and the controls were different according to differences of the principles of the near infrared spectroscopes. In the INVOS 5100C and tNIRS-1, rSO2 values may be related to blood Hb and serum Alb.
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Affiliation(s)
- Yasunori Yagi
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Yasunori Kubo
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Koji Hoshino
- Department of Anesthesiology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazufumi Okada
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
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Orestes O'Brien E, Vural C, Garimella P, Cronin B. Hemodia….WHAT?: Does it matter? J Cardiothorac Vasc Anesth 2023; 37:2181-2183. [PMID: 37648614 DOI: 10.1053/j.jvca.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 09/01/2023]
Affiliation(s)
- E Orestes O'Brien
- Department of Anesthesiology, University of California, San Diego, CA
| | - Corey Vural
- Department of Anesthesiology, University of California, San Diego, CA
| | - Pranav Garimella
- Department of Anesthesiology, University of California, San Diego, CA
| | - Brett Cronin
- Department of Medicine, Division of Nephrology,University of California, San Diego, CA.
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Deo AS, Manjunath D, Prasad A, Deepa D. Perioperative anaesthesia management of renal transplant recipients - A national cross-sectional survey. Indian J Anaesth 2023; 67:S288-S291. [PMID: 38187965 PMCID: PMC10768906 DOI: 10.4103/ija.ija_492_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Alka S. Deo
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - Deepti Manjunath
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - Ambika Prasad
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
| | - D Deepa
- Department of Anaesthesiology, NU Hospitals, Bangalore, Karnataka, India
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Khambaty M, Devalapalli AP, Silbert RE, Kashiwagi DT, Regan DW, Sundsted KK, Mauck KF. Practice Changing Updates in Perioperative Medicine Literature 2022. A Systematic Review. Am J Med 2023; 136:753-762.e1. [PMID: 37148994 DOI: 10.1016/j.amjmed.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
Perioperative medicine is a rapidly growing multidisciplinary field with significant advances published each year. In this review, we highlight important perioperative publications in 2022. A multi-database literature search from January to December of 2022 was undertaken. Original research articles, systematic reviews, meta-analyses, and guidelines were included. Abstracts, case reports, letters, protocols, pediatric and obstetric articles, and cardiac surgery literature were excluded. Two authors reviewed each reference using the Distiller SR systematic review software (Evidence Partners Inc., Ottawa, Ont, Canada). A modified Delphi technique was used to identify 8 practice-changing articles. We identified another 10 articles for tabular summaries. We highlight why these articles have the potential to change clinical perioperative practice and areas where more information is needed.
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Affiliation(s)
- Maleka Khambaty
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Aditya P Devalapalli
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Richard E Silbert
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
| | - Deanne T Kashiwagi
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Sheikh Shakhbout Medical City in partnership with Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Dennis W Regan
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karna K Sundsted
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Medicine, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN
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Cronin B, Vural C, Maus T, O'Brien EO. Perioperative Dialysis: What is "Just Right"? J Cardiothorac Vasc Anesth 2023; 37:501-503. [PMID: 36682920 DOI: 10.1053/j.jvca.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 12/25/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Brett Cronin
- Department of Anesthesiology, University of California, San Diego, CA.
| | - Corey Vural
- Department of Anesthesiology, University of California, San Diego, CA
| | - Timothy Maus
- Department of Anesthesiology, University of California, San Diego, CA
| | - E Orestes O'Brien
- Department of Anesthesiology, University of California, San Diego, CA
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Fielding-Singh V, Vanneman MW, Lin E. Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease-Reply. JAMA 2023; 329:939-940. [PMID: 36943217 DOI: 10.1001/jama.2022.24891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Vikram Fielding-Singh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Matthew W Vanneman
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Eugene Lin
- Department of Internal Medicine, University of Southern California, Los Angeles
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Pal N, Kertai MD, Nelson M. Preoperative Hemodialysis Timing and Postoperative Mortality in Patients With End-stage Kidney Disease. JAMA 2023; 329:939. [PMID: 36943222 DOI: 10.1001/jama.2023.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University, Nashville, Tennessee
| | - Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University, Richmond
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