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Objective To investigate the association between intraoperative hypotension and post-operative acute kidney injury(AKI)in patients undergoing brain tumor resections.Methods A total of 428 patients undergoing elective craniotomy for tumor resection were selected,276 males and 152 females,aged≥18 years,BMI 15-36 kg/m2,ASA physical statusⅡ orⅢ.Based on postoperative occurrence of AKI,the patients were divided into two groups:the AKI group and the control group.This study defined three thresholds for hypotension,including MAP during surgery below 65 mmHg,60 mmHg,and 55 mmHg.Multivariate logistic regression was used to analyze the correlation between intraoperative hypotension and postoperative AKI under three thresholds.Results A total of 107 patients had postoperative AKI.The re-sults of multivariable regression analysis indicated that intraoperative MAP＜65 mmHg(OR = 1.11,95%CI 1.03-1.20,P = 0.010)and intraoperative MAP＜60 mmHg(OR = 1.12,95%CI 1.02-1.23,P = 0.017)were associated with postoperative AKI.Conclusion Intraoperative MAP＜65 mmHg or 60 mmHg is associated with postoperative AKI in patients undergoing brain tumor resection.
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Objective:To investigate the risk factors of postoperative acute kidney injury (AKI) in the elderly patients with intertrochanteric fractures.Methods:The clinical data of elderly patients who underwent surgery for intertrochanteric fractures in Second Affiliated Hospital of Chongqing Medical University from July 2018 to December 2022 were retrospectively analyzed, which was divided into AKI group and non-AKI group according to whether AKI occurred after surgery, with 33 cases in the AKI group and 274 cases in the non-AKI group. The data from two groups of patients including age, gender, body mass index, underlying diseases, Charlson comorbidity index(CCI), pre- and postoperative related laboratory indicators, American Society of Anesthesiologists classification, anesthesia and surgical methods, operation time, intraoperative hypotension, blood transfusion, perioperative medication and other electronic case data were compared. Measurement data with normal distribution were represented as the mean±standard deviation ( ± s), and comparison between groups was conducted using t-test. The measurement data of non-normal distribution were expressed by median (interquartile range) [ M( Q1, Q3)], and the Mann-Whitney U test was used for comparison between groups. Comparison between groups of count data was conducted using the Chi-square test or Fisher exact test. Univariate analysis was conducted on the pertinent indicators of the two groups, and the indicators with statistically significant were chosen for incorporation into the multivariate Logistic regression analysis to investigate the independent risk factors for postoperative AKI. Results:The incidence of postoperative AKI was 10.75% in elderly patients with intertrochanteric fractures. Results of the univariate analysis showed that there were significant differences between the two groups in diabetes mellitus, chronic kidney disease, CCI ≥2, baseline serum creatinine, preoperative blood urea nitrogen, preoperative estimated glomerular filtration rate, preoperative and early postoperative serum albumin levels, intraoperative hypotension, and perioperative blood transfusion( P<0.05). Results of multivariate Logistic regression analysis showed that CCI ≥ 2 ( OR =3.231, 95% CI: 1.150-9.074, P =0.026) and intraoperative hypotension ( OR =4.617, 95% CI: 1.746-12.205, P=0.002) were associated with the occurrence of AKI after intertrochanteric fracture surgery. Conclusion:CCI≥2 and intraoperative hypotension are independent risk factors of postoperative AKI in the elderly patients with intertrochanteric fractures.
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Study Objective: To report the use of a sustained Valsalva maneuver during deliberate hypotension in order to reduce the incidence of distal particle embolization during the neuroangiographic embolization of intracranial arteriovenous malformations (AVMs). Design: Retrospective case series. Patients: 54 cases were studied involving 46 unique patients (20 male, 26 female) seen between January 1, 2007 and December 31, 2008. All patients were ASA class II-III and were undergoing neuroangiographically-assisted embolization for intracranial AVMs. Intervention: Immediately prior to the injection of the embolic substance, each patient received a dose of nitroglycerin to lower their systolic blood pressure from baseline (112- 146 mm Hg) to a target of 55 mm Hg. Next, mechanical ventilation was suspended and manual pressure was applied to the ventilation bag of the anesthesia circuit to maintain a constant airway pressure of 20 cm H2O. This simulated Valsalva maneuver was maintained for 15 seconds after the injection of the embolic material, at which point mechanical ventilation was resumed. Main Results: All patients tolerated the deliberate hypotension/Valsalva protocol well. 2 patients experienced a rupture of the AVM during the procedure.Conclusions: The distal embolization of the embolic material during intracranial AVM embolization is a potentially fatal complication of this procedure. Although our results represent a small case series, they suggest that the use of deliberate arterial hypotension in addition to a simulated Valsalva maneuver may enhance the safety and efficacy of intracranial AVM embolization. Further study, with rigorous control standards and monitoring, is warranted.