Paciente quirúrgico con insuficiencia renal crónica

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Abstract

Se realiza una concisa revisión de los principales aspectos clínicos del paciente con insuficiencia renal crónica en relación con la cirugía y la anestesia, y se recorren tópicos vinculados al riesgo quirúrgico y la farmacología de las drogas anestésicas. Se ofrecen puntos de vista para discutir, entre las tendencias de la práctica especializada actual

Translated abstract

It is made a detailed review of the main clinical aspects connected with surgery and anesthesia in patients suffering from chronic renal failure. Some topics dealing with surgical risk and pharmacology of the anesthetics are also approached. Different points of view about the trends of the present specialized practice are included to be discussed

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Most cited references 28

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CAPD peritonitis. Incidence, pathogens, diagnosis, and management.

M Saklayen (1990)

Peritonitis is a frequent complication of CAPD. Sixty percent of all patients on CAPD will have at least one episode of peritonitis during the first year of this mode of dialysis. Most of the episodes of peritonitis are caused by touch contamination of the dialysis tubing or by extension of the catheter exit site or tunnel infection. Coagulase-negative and coagulase-positive Staphylococcus are the two most common organisms, accounting for 50% or more of all CAPD peritonitis. Other gram-positive and gram-negative bacteria and fungi account for the rest. Intraperitoneal antibiotic treatments are usually effective in eradicating the infection. The choice of antibiotics depends on organisms isolated from cultured dialysate. Fungal peritonitis and, occasionally, Pseudomonas peritonitis require removal of the catheter to eradicate the infection. Prompt identification and treatment of peritonitis are essential to ensure success of a CAPD program. Although with newer techniques, like Y-connector or ultraviolet light system, the rate of peritonitis has declined; however, it has still remained the major complication of the CAPD program.

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Symptomatic hypotension during hemodialysis.

Lee W Henderson (1980)

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Renal function and serum fluoride concentrations in patients with stable renal insufficiency after anesthesia with sevoflurane or enflurane.

P Conzen, M Nuscheler, A Melotte … (1995)

Sevoflurane is metabolized to hexa-fluoro-isopropanol and inorganic fluoride by the human liver. Its use as an anesthetic may lead to peak plasma fluoride concentrations exceeding those seen after enflurane. Although there is no nephrotoxicity after sevoflurane anesthesia in humans with normal kidneys, those with chronically impaired renal function might be at increased risk because of increased fluoride load due to prolonged elimination half-life. In this study, measures of renal function after sevoflurane anesthesia were compared to those after enflurane in patients with chronically impaired renal function. Forty-one elective surgical patients with a stable preoperative serum creatinine concentration > or = 1.5 mg/dL were randomly allocated to receive sevoflurane (n = 21) or enflurane (n = 20) at a fresh gas inflow rate of 4 L/min for maintenance of anesthesia. Serum fluoride concentrations were measured by ion-selective electrode. Renal function (creatinine, urea, sodium, osmolality) was assessed in serum and urine preoperatively and for up to 7 days postoperatively. Peak serum inorganic fluoride concentrations were significantly higher after sevoflurane than after enflurane anesthesia (25.0 +/- 2.2 vs 13.3 +/- 1.1 microM; mean +/- SEM). Laboratory measures of renal function Laboratory measures of renal function remained stable throughout the postoperative period in both groups. No patient suffered a permanent deterioration of preexisting renal insufficiency and none required dialysis. Thus, neither sevoflurane nor enflurane deteriorated postoperative renal function in these patients with preexisting renal insufficiency. There is no evidence that fluoride released by metabolism of sevoflurane metabolism worsened renal function in these patients with stable, permanent serum creatinine concentrations more than 1.5 mg/dL.(ABSTRACT TRUNCATED AT 250 WORDS)

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Author and article information

Contributors

Jorge Enrique Trujillo Salgado: Role: ND

Yolanda Sotolongo Molina: Role: ND

María Isabel Gutiérrez: Role: ND

Alexánder Mármol Sóñora: Role: ND

Journal

Journal ID (publisher): cir

Title: Revista Cubana de Cirugía

Abbreviated Title: Rev Cubana Cir

Publisher: Editorial Ciencias Médicas (Ciudad de la Habana )

ISSN: 1561-2945

Publication date (Print): April 1998

Volume: 37

Issue: 1

Pages: 27-34

Affiliations

[1 ] Instituto de Nefrología Cuba

Article

Publisher ID: S0034-74931998000100004

SO-VID: ee609f94-0091-4cec-b832-794aafe6f64f

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http://creativecommons.org/licenses/by/4.0/

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SciELO Cuba

Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0034-7493&lng=en

Paciente quirúrgico con insuficiencia renal crónica

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Abstract

Translated abstract

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SciELO Cuba

Most cited references 28

CAPD peritonitis. Incidence, pathogens, diagnosis, and management.

Symptomatic hypotension during hemodialysis.

Renal function and serum fluoride concentrations in patients with stable renal insufficiency after anesthesia with sevoflurane or enflurane.

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