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121.
122.
Ji Su Jang Yeon‐Hee Lee Hemant K. Kandahar Suman K. Shrestha Jae Sung Lee Jin‐Koo Lee Seung Jae Park Na Rea Lee Jae Jun Lee Sang‐Soo Lee 《Brazilian Journal of Anesthesiology》2018,68(6):558-563
Background and objectives
An ultrasound guided femoral nerve block is an established analgesic method in patients with a hip fracture. Elevated cytokine levels correlate with poor patient outcomes after surgery. Hence, the aim of the study was to describe the levels of tumor necrosis factor‐α after an ultrasound‐guided femoral nerve block in elderly patients having a femoral neck fracture.Methods
A total of 32 patients were allocated into two treatment groups: 16 patients (femoral nerve block group; ultrasound‐guided femoral nerve block with up to 20 mL of 0.3 mL.kg?1 of 0.5% bupivacaine and intravenous tramadol) and 16 patients (standard management group; up to 3 mL of 0.9% saline in the femoral sheath and intravenous tramadol). Tumor necrosis factor‐α and visual analogue scale scores were evaluated immediately before the femoral nerve block and again at 4, 24, and 48 h after the femoral nerve block. All surgery was performed electively after 48 h of femoral nerve block.Results
The femoral nerve block group had a significantly lower mean tumor necrosis factor‐α level at 24 (4.60 vs. 8.14, p < 0.001) and 48 h (5.05 vs. 8.56, p < 0.001) after the femoral nerve block, compared to the standard management group. The femoral nerve block group showed a significantly lower mean visual analogue scale score at 4 (3.63 vs. 7.06, p < 0.001) and 24 h (4.50 vs. 5.75, p < 0.001) after the femoral nerve block, compared to the standard management group.Conclusions
Ultrasound‐guided femoral nerve block using 0.3 mL.kg?1 of 0.5% bupivacaine up to a maximum of 20 mL resulted in a significant lower tumor necrosis factor‐α level. 相似文献123.
J.C. Na J.S. Park M.-G. Yoon H.H. Lee Y.E. Yoon K.H. Huh Y.S. Kim W.K. Han 《Transplantation proceedings》2018,50(4):1018-1021
Background
Although renal function recovery of living kidney donors has been reported in a number of studies, many patients show poor recovery, and the long-term prognosis of these patients has not been well studied. In this investigation we explored the long-term prognosis of renal function in patients with chronic kidney disease (CKD) at 1 year after nephrectomy.Methods
Patients who underwent donor nephrectomy during the period from March 2006 to April 2014, with a follow-up creatinine study at 1 year postoperatively and more than 3 years of follow-up, were included in the study. Creatinine and estimated glomerular filtration rate (eGFR, using the Modification of Diet in Renal Disease formula) before and after surgery were studied. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood count, preoperative routine serum chemistry, and urine study results were reviewed.Results
Among 841 patients who had donor nephrectomy, 362 were included in the study. There were 111 patients (30.6%) with eGFR <60 mL/min/1.73 m2 at 1 year postsurgery, and the median follow-up period was 62.8 months (interquartile range [IQR] 42.0–86.3 months). The maximum eGFR after 3-year follow-up was studied, and 48 patients (43.2%) never recovered eGFR to >60 mL/min/1.73 m2. Age, history of hypertension, preoperative eGFR, and eGFR at 1 year were predictive factors at univariate analysis. Multivariate analysis of these factors was studied, and age (52.5 [IQR 47–55.7] vs 47 [IQR 7–53] years, odds ratio [OR] 1.1, 95% confidence interval [CI] 1.02–1.15, P = .007), history of hypertension (16.7% vs 1.6%, OR 10.0, 95% CI 1.09–92.49, P = .042), and eGFR at 1 year (53.9 [IQR 50.3–56.0] vs 57.0 [IQR 54.2–58.4] mL/min/1.73 m2, OR 0.8, 95% CI 0.72–0.92, P = .002) remained as significant risk factors.Conclusion
Of all living donors, 15.7% had CKD after >3 years of follow-up. Close observation is warranted when donors have CKD after 1 year follow-up, as 43.2% fail to recover renal function. Patients who are older, have a history of hypertension, and have low eGFR at 1-year follow-up are especially at risk. 相似文献124.
J.Y. Park M.H. Kim E.J. Bae S. Kim D.K. Kim K.W. Joo Y.S. Kim J.P. Lee Y.H. Kim C.S. Lim 《Transplantation proceedings》2018,50(4):1068-1073
Background
Comorbid conditions are important in the survival of kidney transplant recipients. The weights assigned to comorbidities to predict survival may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in renal allograft recipients (mCCI-KT), thereby improving risk stratification for mortality.Methods
A total of 3765 recipients in a multicenter cohort were included to develop a comorbidity score. The weights of the comorbidities, per the CCI, were recalibrated using a Cox proportional hazards model.Results
Peripheral vascular disease, liver disease, myocardial infarction, and diabetes in the CCI were selected from the Cox proportional hazards model. Thus, the mCCI-KT included 4 comorbidities with recalibrated severity weights. Whereas the CCI did not discriminate for survival, the mCCI-KT provided significant discrimination for survival using the Kaplan-Meier method and Cox regression analysis. The mCCI-KT showed modest increases in c-statistics (0.54 vs 0.52, P = .001) and improved net mortality risk reclassification by 16.3% (95% confidence interval, 3.2–29.4; P = .015) relative to the CCI.Conclusion
The mCCI-KT stratifies the risk for mortality in renal allograft recipients better than the CCI, suggesting that it may be a preferred index for use in clinical practice. 相似文献125.
126.
M. Hur S.-K. Park D. E. Jung S. Yoo J.-Y. Choi W. H. Kim J. T. Kim J.-H. Bahk 《Der Anaesthesist》2018,67(11):859-867
Background
Gas exchange disturbance may develop during urologic robotic laparoscopic surgery with the patient in a steep Trendelenburg position. This study investigated whether prolonged inspiratory time could mitigate gas exchange disturbances including hypercapnia.Methods
In this randomized cross-over trial, 32 patients scheduled for robot-assisted urologic surgery were randomized to receive an inspiratory to expiratory time ratio (I:E) of 1:1 for the first hour of pneumoperitoneum followed by 1:2 for last period of surgery (group A, n?=?17) or I:E of 1:2 followed by 1:1 (group B, n?=?15). Arterial blood gas analysis, airway pressure and hemodynamic variables were assessed at four time points (T1: 10?min after induction of general anesthesia, T2: 1?h after the initiation of pneumoperitoneum, T3: 1?h after T2 and T4: at skin closure). The carry over effect of initial I:E was also evaluated over the next hour through arterial blood gas analysis.Results
There was a significant decrease in partial pressure of oxygen in arterial blood (PaO2) for both groups at T2 and T3 compared to T1 but in group B the PaO2 at T4 was not decreased from the baseline. Partial pressure of carbon dioxide in arterial blood (PaCO2) increased with I:E of 1:2 but did not significantly increase with I:E of 1:1; however, there were no differences in PaO2 and PaCO2 between the groups.Conclusion
Decreased oxygenation by pneumoperitoneum was improved and PaCO2 did not increase after 1 h of I:E of 1:1; however, the effect of equal ratio ventilation longer than 1 h remains to be determined. There was no carryover effect of the two different I:E ratios.127.
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