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World Neurosurg 2019 Sep 29;129:e452-e457. Epub 2019 May 29.

Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.

Objective: To present a preliminary experience of perioperative management for patients with spinal tuberculosis (STB) and end-stage renal disease (ESRD) and discuss strategic factors that should be considered.

Methods: A retrospective study of 6 patients with STB and ESRD who underwent spine surgeries in our hospital from January 2010 to May 2017 was carried out. Medical records were reviewed for clinical manifestations, laboratory examinations, radiologic findings, perioperative management, clinical outcomes, and complications. Read More

Clin Podiatr Med Surg 2019 Jan 26;36(1):59-82. Epub 2018 Oct 26.

Nephrology, Princeton Community Hospital, 122 12th Street, Princeton, WV 24740, USA.

Treating patients with kidney disease can be both a difficult and a complex process. Understanding how to care for patients who have kidney disease is essential for lowering perioperative as well as periprocedural morbidity and mortality. The primary aim in renal evaluation and care is to control and mitigate factors that may result in acute kidney injury (AKI) and/or cause further decline in renal function. Read More

Minim Invasive Ther Allied Technol 2019 Feb 11;28(1):41-45. Epub 2018 Sep 11.

a Department of Gynecology , Qianfoshan Hospital Affiliated to Shandong University , Jinan , China.

Background: Chronic renal failure (CRF) in women is frequently accompanied by endocrine disturbances leading to abnormal uterine bleeding (AUB). Recurrence of AUB is the most significant problem following current treatment approaches. Laparoscopic hysterectomy (LH) might be taken into consideration for patients who no longer want to preserve their fertility; however, these patients are in high-risk groups for minimally invasive surgery. Read More

Clin Orthop Relat Res 2019 01;477(1):177-190

J. K. Wong, T. E. Kim, S. C. Mudumbai, S. K. Howard, E. R. Mariano, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA J. K. Wong, T. E. Kim, S. C. Mudumbai, S. K. Howard, R. King, E. R. Mariano, Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA S. G. Memtsoudis, Departments of Anesthesiology and Public Health, Weill Cornell Medical College, New York, NY, USA S. G. Memtsoudis, Department of Anesthesiology, Hospital for Special Surgery, New York, NY, USA N. J. Giori, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA N. J. Giori, Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA R. K. Oka, Office of Nursing Service, Veterans Affairs Central Office, Washington, DC, USA.

Background: Hospital-related factors associated with mortality and morbidity after hip fracture surgery are not completely understood. The Veterans Health Administration (VHA) is the largest single-payer, networked healthcare system in the country serving a relatively homogenous patient population with facilities that vary in size and resource availability. These characteristics provide some degree of financial and patient-level controls to explore the association, if any, between surgical volume and facility resource availability and hospital performance regarding postoperative complications after hip fracture surgery. Read More

Anesth Analg 2018 11;127(5):1236-1245

Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania.

Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Read More

Anaesth Crit Care Pain Med 2018 06 17;37 Suppl 1:S9-S19. Epub 2018 Mar 17.

Service d'anesthésie - réanimation chirurgicale, hôpitaux universitaires Paris-Sud, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France. Electronic address:

In diabetic patients undergoing surgery, we recommend assessing glycaemic control preoperatively by assessing glycated haemoglobin (HbA1c) levels and recent capillary blood sugar (glucose) levels, and to adjust any treatments accordingly before surgery, paying particular attention to specific complications of diabetes. Gastroparesis creates a risk of stasis and aspiration of gastric content at induction of anaesthesia requiring the use of a rapid sequence induction technique. Cardiac involvement can be divided into several types. Read More

J Vasc Surg 2018 09 6;68(3):796-806.e1. Epub 2018 Mar 6.

Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.

Objective: Performing lower extremity bypass (LEB) in actively smoking claudicants remains controversial. Whereas some surgeons advocate a strict nonoperative approach to active smokers, citing perceived inferior outcomes, others will proceed with surgical bypass if the patient is anatomically suited and medical management has failed. The purpose of this study was to determine the impact of active smoking on LEB outcomes among claudicants. Read More

Anesth Analg 2018 09;127(3):678-687

From the Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.

Background: The global rate of major noncardiac surgical procedures is increasing annually, and of those patients presenting for surgery, increasing numbers are taking either an angiotensin-converting enzyme inhibitor (ACE-I) or an angiotensin receptor blocker (ARB). The current recommendations of whether to continue or withhold ACE-I and ARB in the perioperative period are conflicting. Previous meta-analyses have linked preoperative ACE-I/ARB therapy to the increased incidence of postinduction hypotension; however, they have failed to correlate this with adverse patient outcomes. Read More

Medicine (Baltimore) 2017 Jan;96(1):e5820

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.

Preservation of adequate perfusion pressures to the graft is a main focus of intraoperative management during kidney transplantation. We undertook this study to investigate the incidence of the higher use of inotropes in kidney transplant recipients and identify the patient outcomes and preoperative and intraoperative variables related to this.We retrospectively analyzed 1053 patients who underwent kidney transplantation at Asan Medical Center between January 2006 and February 2012, stratified by their inotropic score ([dopamine] + [dobutamine] + [epinephrine × 100] + [norepinephrine × 100]) <7 versus ≥7, wherein all doses are expressed as μg/kg/min. Read More

Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2016 Nov;37(2-3):121-125

Kidney transplantations have become common surgical procedures that are associated with high success rates. Nevertheless, the detection, accurate diagnosis and timely management of the perioperative surgical complications sometimes require multidisciplinary team approach for some of the complications may result in significant morbidity, risk of graft loss and/or mortality of the recipient. A case of a 24-year old male patient that developed a number of different surgical complications is reported. Read More

Anesthesiol Clin 2016 Dec;34(4):645-658

Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 622 West 168th Street-PH 5, New York, NY 10032, USA.

Hepatic and renal disease are common comorbidities in patients presenting for intermediate- and high-risk surgery. With the evolution of perioperative medicine, anesthesiologists are encountering more patients who have significant hepatic and renal disease, both acute and chronic in nature. It is important that anesthesiologists have an in-depth understanding of the physiologic derangements seen with hepatic and renal disease to evaluate and manage these patients appropriately. Read More

Anesth Analg 2016 May;122(5):1335-9

From the Department of Anesthesiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada.

An understanding of the potential mechanisms underlying recurrent upper airway collapse may help anesthesiologists better manage patients in the postoperative period. There is convincing evidence in the sleep medicine literature to suggest that a positive fluid and salt balance can worsen upper airway collapse in patients with obstructive sleep apnea through the redistribution of fluid from the legs into the neck and upper airway while supine, in a process known as "rostral fluid shift." According to this theory, during the day the volume from a fluid bolus or from fluid overload states (i. Read More

Curr Opin Anaesthesiol 2016 Jun;29(3):413-20

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Muenster, Muenster, Germany.

Purpose Of Review: Chronic kidney disease (CKD) is an increasing health problem worldwide and is associated with a number of clinical challenges. In this paper, we review recent studies that deal with strategies for the management of patients with CKD undergoing surgery.

Recent Findings: Effective strategies for nephroprotection are crucial for the handling of patients with CKD in the perioperative setting to prevent complications and to avoid the progression of CKD. Read More

Wien Med Wochenschr 2015 Dec 30;165(23-24):467-71. Epub 2015 Nov 30.

Oncological Palliative Medicine, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland.

A 67-year-old patient with coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was scheduled for coronary artery bypass graft (CABG) surgery after a recent myocardial infarction despite a high perioperative risk of death. While waiting, acute renal failure developed, and the patient was admitted to the intensive care unit (ICU). After the patient and his wife were informed that CABG surgery was no longer possible, he declined further intensive care treatment and subsequently died peacefully. Read More

Minerva Cardioangiol 2016 Apr 16;64(2):195-203. Epub 2015 Oct 16.

Division of Vascular Surgery, University of Siena, Siena, Italy -

Endovascular aortic repair (EVAR) for abdominal aortic aneurysms (AAA) is the preferred first treatment option in case of patients with advanced age and/or fit anatomy owing to shorter length of in hospital staying, less complications or laparotomy-related re-interventions, and lower initial costs. Although it is a less-invasive intervention, EVAR entails a risk similar to that of open aortic procedures for medical comorbidities, and a perioperative clinical evaluation is mandatory to minimize the early and late cardiovascular risk. In this brief review the determinants of cardiac risk (functional capacity, cardiac evaluation, non-invasive tests, bio markers and "specialist" cardiac tests) as well the most widely used predictive risk scores were analyzed. Read More

Pediatr Emerg Care 2015 Sep;31(9):649-51

From the *Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD; †Divisions of Critical Care Medicine and Anesthesiology and Perioperative Medicine, Children's National Medical Center, Washington, DC; and ‡Department of Anesthesiology and Critical Care Medicine & Pediatrics, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

Aortic dissection secondary to thoracoabdominal aortic aneurysms is very uncommon in children, and this life-threatening diagnosis requires a high clinical index of suspicion. Unlike adults, in whom atherosclerosis, inflammation, and advanced age are typically contributing factors, aortic dissection in children is usually due to nonatherosclerotic causes.Aortic aneurysms can be asymptomatic when small but, when significantly enlarged, can compromise organ function and dissect, resulting in high mortality rates. Read More

Surg Laparosc Endosc Percutan Tech 2014 Aug;24(4):e146-50

*Department of Surgery, Division of General Surgery, Min-Sheng General Hospital, Taoyuan †Department of Surgery, Division of General Surgery, Mackay Memorial Hospital, Taipei, Taiwan ‡Taiwan Mackay Medicine, Nursing and Management College, Taipei, Taiwan, ROC.

Background: Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for patients with end-stage renal disease (ESRD). Peritoneal dialysis catheters are usually placed using a small laparotomy. This traditional technique is usually safe if well executed, but it cannot be safely performed if the patient has had a previous abdominal operation. Read More

Masui 2013 Mar;62(3):322-5

Department of Anesthesiology, Rinku General Medical Center, Izumisano 598-8577.

The transversus abdominis plane (TAP) block is a newly described technique introducing a local anesthetic agent between the internal oblique and the transversus abdominis muscles of the abdominal wall, which is safer and more reliable analgesia in recent years by ultrasound technique. We report the perioperative management of transversus abdominis plane block with catheterization for a patient with severe cardiac dysfunction and chronic kidney failure, who underwent bilateral inguinal hernioplasty. A bilateral TAP block was first performed with 0. Read More

Semin Dial 2011 May-Jun;24(3):314-26. Epub 2011 Mar 25.

Department of Anaesthetics and Intensive Care Medicine, Craigavon Area Hospital, Portadown, United Kingdom.

Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6. Read More

Ann Acad Med Singapore 2010 Sep;39(9):670-5

Department of General Surgery, Tan Tock Seng Hospital, Singapore.

Introduction: Hand infections in patients with end-stage renal failure (ESRF) are more diffi cult to treat and have had the worse outcomes. This paper examines the epidemiology, bacteriology and outcomes of surgically managed upper limb infections in these vulnerable patients.

Materials And Methods: All patients from a single centre with surgically-managed upper limb infections between 2001 and 2007 were reviewed. Read More

Masui 2010 Aug;59(8):1021-4

Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama 700-8558.

We report the perioperative management of a 55-year-old man with chronic renal failure requiring long-term hemodialysis, who underwent laparoscopic adrenalectomy for pheochromocytoma. He was pretreated with doxazosin, a calcium channel blocker and a beta-adrenoceptor antagonist to control blood pressure until surgery. His dry weight increased slowly from 57 kg to 58. Read More

Reg Anesth Pain Med 2009 Jan-Feb;34(1):69-71

Department of Anaesthesia and daggerSurgery, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Objective: This case report describes the anesthetic management of a patient with severe chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) who underwent elective sigmoid resection under combined spinal-epidural anesthesia and bilevel positive airway pressure (BiPAP).

Case Report: A 63-year-old man with diverticular disease presented for a sigmoid resection. His medical history included coronary artery bypass grafting, diabetes mellitus, gastroesophageal reflux, chronic renal failure, COPD, a paralyzed left hemidiaphragm, and OSA treated with nighttime BiPAP and oxygen. Read More

Oral Maxillofac Surg Clin North Am 2006 May;18(2):203-12, vi

Department of Oral and Maxillofacial Surgery, Hospital of University of Pennsylvania, 3400 Spruce Street, 5 White, Philadelphia, PA 19104, USA.

The patient who has renal disease is susceptible to many potential complications during the perioperative period. The prevention of postoperative acute renal failure (ARF), especially in patients who have existing chronic kidney disease, and management of patients who have end-stage renal disease (ESRD) who are undergoing surgery are challenging. Elimination of risk factors for ARF and early diagnosis of ARF should improve patient outcomes. Read More

Curr Opin Crit Care 2006 Aug;12(4):340-5

Department of Critical Care Medicine, University of Toronto, St. Michael's Hospital, Ontario, Canada.

Purpose Of Review: Abdominal aortic aneurysms still require open repair despite the advances that endovascular aneurysm repair has made in treating patients with significant operative risk. Older patients with significant comorbidities require open repair of their complex aneurysms when they fail to meet anatomic criteria for endovascular aneurysm repair. This review discusses the physiologic insult of abdominal aortic surgery. Read More

BJU Int 2005 Aug;96(2):223-9

Department of Anaesthesia, Hammersmith Hospital, London, UK.

Anaesthesia for urological surgery poses particular challenges for the anaesthetist related to the patient population and procedure type. The aim of this article is to cover the general principles of anaesthesia, with dedicated sections relevant to practising urological surgeons. This represents vast amounts of knowledge that cannot be covered in one article. Read More

Rev Bras Anestesiol 2004 Dec;54(6):799-801

CET/SBA, Hospital Felício Rocho.

Background And Objectives: Mckusick-Kaufman syndrome is an uncommon disease, typically characterized by hydrometrocolpos, polydactyly and congenital heart defects. These patients are often submitted to different surgical procedures throughout their lives and the anesthesiologist must be prepared to deal with possible complications. This article aimed at reporting the anesthetic management adopted for a patient with this syndrome. Read More

Kyobu Geka 2004 Nov;57(12):1094-8

Department of Thoracic-Cardiovascular Surgery, Ehime Rosai General Hospital, Niihama, Japan.

An 82-year-old man who had been undergoing hemodialysis for chronic renal failure, 3 times a week for the last 3 years, was admitted to our hospital for the treatment of lung cancer. Under careful perioperative management, we successfully performed a lobectomy. Histological examination revealed well differentiated squamous cell carcinoma and the postoperative staging was pT1N0M0. Read More

Di Yi Jun Yi Da Xue Xue Bao 2003 Sep;23(9):972-4

Department of Renal Transplantation, Nanfang Hospital, First Military Medical University, Guangzhou 510515, China.

Objective: To study the surgical techniques, perioperative management, management of infections and graft rejection in patients with combined liver-kidney transplantation (CLKT).

Methods: CLKT was performed in a 66-year-old patient with alcoholic liver cirrhosis and uremia. Lavage in situ with University of Wisconsin (UW) solution of the donor organs and en hoc resection was performed. Read More

Surg Endosc 2001 Oct;15(10):1217-20

Department of Minimally Invasive Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A80, Cleveland, OH 44195, USA.

Background: As opposed to acute, chronic, and acalculus cholecystitis, emphysematous cholecystitis (EC) is associated with significant morbidity and mortality. Only a few studies have specifically reviewed the operative management and clinical outcome of EC. This study documents the operative management and clinical outcome of EC at the Cleveland Clinic Foundation. Read More

Pediatr Nephrol 2001 Apr;16(4):315-7

Children's Hospital, Hannover Medical School, 30623 Hannover, Germany.

Central diabetes insipidus is clinically masked in dialysis patients. We report a 12-year-old girl receiving a living-related donor graft for renal failure from Alport syndrome, in whom a craniopharyngioma had been resected 6 months before transplantation. Pretransplant evaluation had documented central hypothyroidism, growth hormone deficiency, and presumptive hypogonadotropic hypogonadism. Read More

Am J Kidney Dis 1997 May;29(5):759-62

Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8029, USA.

Renal osteodystrophy is a common problem in patients with end-stage renal disease. Severe secondary hyperparathyroidism unresponsive to an intensive regimen of diet, phosphate binders, and calcitriol therapy is an indication for surgical parathyroidectomy. Certain unique postoperative electrolyte aberrations are seen after parathyroidectomy, including severe hypocalcemia and hypophosphatemia (hungry bone syndrome), as well as hyperkalemia. Read More

J Vasc Surg 1989 Mar;9(3):437-47

Canadian Society for Vascular Surgery, Aneurysm Study Group, Toronto, Ontario.

A previous article (Part I) described the patient population and operative management of 666 patients who had surgery for nonruptured abdominal aortic aneurysms. This article details the perioperative complications and, by chi-square and logistic regression analysis, identifies the variables that are associated with each complication. In summarizing the results (below) the incidence of each complication is listed, along with the predictive risk factors in parentheses that have significance levels less than 0. Read More

J Urol 1985 Mar;133(3):379-82

From May 1977 to June 1983, 198 patients were accepted as candidates for renal transplantation at our university. We review our experience with 14 consecutive patients who underwent selective pre-transplant nephrectomy during this interval. Indications for this procedure included recurrent or chronic pyelonephritis, structural abnormalities of the urinary tract predisposing the patient to infection, malignant or renin-dependent hypertension, Goodpasture's disease, certain cases of rapidly progressive glomerulonephritis and selected patients with polycystic kidneys. Read More