Incidence and outcome of contrast-associated acute kidney injury assessed with Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients of medical and surgical intensive care units: a retrospective study.

BACKGROUND: Contrast medium used for radiologic tests can decrease renal function. However there have been few studies on contrast-associated acute kidney injury in intensive care unit (ICU) patients. The objective of this study was to evaluate the incidence, characteristics, and outcome of contrast-associated acute kidney injury (CA-AKI) patients using the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) criteria in critically ill patients in the ICU. METHODS: We conducted a retrospective study of adult patients who underwent contrast-enhanced radiologic tests from January 2011 to December 2012 in a 30-bed medical ICU and a 24-bed surgical ICU. RESULTS: The study included 335 patients, and the incidence of CA-AKI was 15.5%. The serum creatinine and estimated glomerular filtration rate values in the CA-AKI patients did not recover even at discharge from the hospital compared with the values prior to the contrast use. Among 52 CA-AKI patients, 55.8% (n = 29) had pre-existing kidney injury and 44.2% (n = 23) did not. The CA-AKI patients were divided into risk (31%), injury (31%), and failure (38%) by the RIFLE classification. The percentage of patients in whom AKI progressed to a more severe form (failure, loss, end-stage kidney disease) increased from 38% to 45% during the hospital stay, and the recovery rate of AKI was 17% at the time of hospital discharge. Because the Acute Physiology and Chronic Health Evaluation (APACHE) II score was the only significant variable inducing CA-AKI, higher APACHE II scores were associated with a higher risk of CA-AKI. The ICU and hospital mortality of patients with CA-AKI was significantly higher than in patients without CA-AKI. CONCLUSIONS: CA-AKI is associated with increases in hospital mortality, and can be predicted by the APACHE score. TRIAL REGISTRATION: NCT01807195 on March. 06. 2013.

Intensity of extremely low-frequency electromagnetic fields produced in operating rooms during surgery at the standing position of anesthesiologists.

BACKGROUND: Numerous electronic devices have been introduced into operating rooms. Although little is known about the relationship between exposure to electromagnetic fields and health hazards, several studies have demonstrated causal relationships between electromagnetic fields exposure and various symptoms, cancers, and other diseases. METHODS: This study was approved by the Institutional Review Board. The intensity of extremely low-frequency electromagnetic fields was measured during surgery with the extremely low-frequency electromagnetic field strength measurement system at the standing position of anesthesiologists in 18 operating rooms and analyzed with EMDEX analysis and graphical program (EMCALC 95; ENERTECH, Campbell, CA). RESULTS: The average measurement duration per operating room per day was 7.41 +/- 0.70 h (mean +/- SD). The average sample number of measurements was 888.11 +/- 82.75 per operating room. The average magnetic field was 5.83 +/- 5.23 milliGuass (mG) (range, 0.10-33.80 mG), with 70% of these levels 2 mG or greater. CONCLUSIONS: The authors' results indicate that anesthesiologists in operating rooms are exposed to extremely low-frequency electromagnetic field levels that exceed magnetic field intensity of 2 mG recommended by the Swedish Board for Technical Accreditation for production by computer monitors and detected 30 cm from them. It currently is not clear if this exposure has health effects on anesthesiologists and other operating room personnel.

Stress-induced cardiomyopathy following cephalosporin-induced anaphylactic shock during general anesthesia.

PURPOSE: Anaphylaxis may be caused by various agents during general anesthesia. Sympathetic discharge may occur during anaphylaxis, which can trigger transient cardiomyopathy. We describe a case of stress-induced cardiomyopathy that occurred in association with an anaphylactic reaction during general anesthesia. CLINICAL FEATURES: A 32-year-old female undergoing laparoscopic enucleation of an ovarian cyst developed a severe anaphylactic reaction after cephalosporin infusion during general anesthesia. Her vital signs responded favourably to immediate resuscitative maneuvers, but cardiovascular collapse reappeared with transient ventricular tachycardia shortly after her transfer to the intensive care unit. ST-segment elevation appeared in electrocardiographic leads V(2)-V(6) and echocardiography showed diffuse regional wall motion abnormalities in the midventricular level. Increased MB fractions of creatine kinase and troponin T levels indicated myocardial necrosis, but cardiac catheterization demonstrated normal coronary arteries. Management was supportive and she was discharged 2 days after the onset of anaphylactic symptoms, without sequelae. A diagnosis of stress-induced cardiomyopathy of a midventricular type following anaphylaxis was made on the basis of the clinical features and the findings of cardiac evaluations. CONCLUSIONS: Transient, reversible left-ventricular dysfunction is a recently recognized phenomenon that may occur in the setting of anaphylactic reactions during the perioperative period.