Incidence of acute kidney injury post cardiac surgery: a comparison of the AKIN and KDIGO criteria.

BACKGROUND AND OBJECTIVES: Data on urine output have not been routinely presented to define cardiac surgery-related acute kidney injury (AKI). We evaluated the incidence of AKI after cardiac surgery based on the AKIN and KDIGO criteria (considering serum creatinine concentration and urine output in the first 72 hours postoperatively) and compared the performance of the 2 criteria for AKI staging. METHODS: This was a prospective cohort study of adult patients undergoing coronary artery bypass grafting (CABG), valve replacement, or CABG + valve replacement between October 2017 and April 2018 at a single institution. Patients were excluded if baseline creatinine concentration (measured within 7 days before surgery) was ≥ 2.5 mg.dL-1. Patients were evaluated for the development of AKI based on changes in urine output and serum creatinine concentration, measured daily from postoperative day 1 to 7, according to the AKIN and KDIGO criteria, which were then compared. RESULTS: A total of 198 patients were included. AKI occurred in 83.8% by AKIN and in 82.8% by KDIGO, when using both urine output and serum creatinine concentration as defining criteria. Using serum creatinine concentration alone, the incidence of AKI fell to 27.3% by AKIN and to 24.7% by KDIGO. A kappa coefficient of 0.98 was obtained between the AKIN and KDIGO criteria. CONCLUSIONS: Almost perfect agreement was found between AKIN and KDIGO. AKI may be underdiagnosed after cardiac surgery if serum creatinine concentration is used as the only defining criterion. Our findings underscore the fundamental importance of using the urine output criterion in the assessment of patients at risk for AKI.

Effect of endovenous lidocaine on analgesia and serum cytokines: double-blinded and randomized trial.

STUDY OBJECTIVE: This trial aimed to compare postoperative analgesia, opioid consumption, duration of ileus and hospital stay, and cytokine levels in patients undergoing laparoscopic cholecystectomies who received intravenous lidocaine in comparison with a control group. DESIGN: Prospective, longitudinal, double-blind, and randomized study. SETTING: Operating room and postoperative recovery area. PATIENTS: Forty-four American Society of Anesthesiologists I and II patients older than 17 years, undergoing laparoscopic cholecystectomy, under general anesthesia. INTERVENTIONS: The first group received intravenous lidocaine during the procedure until 1 hour postoperatively, whereas the second group received saline. Both groups received dipyrone and morphine patient-controlled analgesia. MEASUREMENTS: Pain was assessed by Visual Numeric Scale at rest and when coughing at different times after the end of the surgery. Blood samples were taken at the end of procedure and 24 hours later. The total morphine patient-controlled analgesia demand, the time for the first flatus, and the length of hospital stay were also recorded. MAIN RESULTS: Groups were similar in relation to sex (P= .2), age (P= .5), weight (P= .08), and length of surgery (P= .6). No differences were observed regarding the intensity of postoperative pain between the groups, either at rest (P= .76) or when coughing (P= .31), in morphine consumption (P= .9), and in the duration of ileus (P= .5) or length of hospital stay (P= .9). The inflammatory markers interleukin (IL)-1 (P= .02), IL-6 (P< .01), interferon-γ (P< .01), and tumor necrosis factor α (P< .01) showed significant reduction in the lidocaine group against the placebo group, except IL-10 (P= .01), that, because of its anti-inflammatory effects, increased its concentration. CONCLUSIONS: Intravenous lidocaine was not able to reduce postoperative pain, opioid consumption, and duration of ileus or length of hospital stay. However, its anti-inflammatory effect was noticeable.