Effect of anesthesia management based on rSO2-BIS-goal-directed hemodynamic multi-modal monitoring on acute kidney injury after cardiac valve replacement / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of anesthesia management based on regional cerebral oxygen saturation (rSO2)-bispectral index (BIS)-goal-directed hemodynamic multi-modal monitoring on acute kidney injury (AKI) after cardiac valve replacement.Methods A total of 238 patients of both sexes,aged 18-75 yr,weighing 45-95 kg,of American Society of Anesthesiologists physical status Ⅲ or Ⅳ (New York Heart Association class Ⅱ or Ⅲ),undergoing elective cardiac valve replacement,were assigned into routine experience group (group C,n=122) and multi-mode monitoring group (group M,n=116) using a random number table method.After admission to the operating room,the invasive blood pressure of radial artery,central venous pressure,electrocardiogram,SpO2 and end-tidal pressure of carbon dioxide were recorded in group C,and rSO2,BIS,stroke volume variation,cardiac index and stroke volume index were monitored based on the monitoring in group C.The patients were tracheally intubated when BIS value was about 50.BIS value was maintained between 45 and 55,rSO2was maintained not less than 20％ of the baseline value or the absolute value not less than 55％,and fluctuation in mean arterial pressure did not exceed 20％ of the baseline value,and stroke volume index was maintained ＞25 ml/m2and cardiac index＞2.5 L ·rmin-1 · m-2,maintaining not lower than the baseline value before induction in special conditions.The intraoperative volume of fluid infused,infusion of allogeneic blood,consumption of propofol,time of cardiopulmonary bypass,aortic cross-clamping time,anesthesia time,operation time,occurrence of AKI within 48 h after operation,renal replacement therapy,extubation time,duration of intensive care unit stay,postoperative length of hospital stay,development of other serious postoperative complications and fatality rate at day 30 after operation were recorded.Results Compared with group C,the incidence of AKI was significantly decreased,the volume of plasma infused and consumption of propofol were reduced,the extubation time,duration of intensive care unit stay and postoperative length of hospital stay were shortened (P＜0.05),and no significant change was found in the rate of renal replacement therapy,constituent ratio of AKI degree,incidence of other serious postoperative complications or mortality rate at day 30 after operation in group M (P＞0.05).Conclusion Anesthesia management based on rSO2-BIS-goal-directed hemodynamic multi-modal monitoring can decrease the occurrence of AKI after cardiac Valve replacement.