The Greek e-journal of Perioperative Medicine

3-23

Authors: Pantelidis A, Resvani P, Tsaousi G

Acute sepsis-related kidney damage (S-AKI) is a common complication of the critically ill patient, with high mortality rates. Prevention of S-AKI is a daunting task because by the time patients seek medical help, most have already developed acute kidney damage. Thus early detection is an issue of utmost importance. Recent studies show that microvascular dysfunction, inflammation and metabolic reprogramming are the three fundamental mechanisms that contribute to the development of S-AKI. The rapid diagnosis of S-AKI aims to minimize the deterioration of renal function. Research on this field is intensive with particular emphasis on the discovery of new biomarkers with enhanced sensitivity in renal function assessment. Neutrophil gelatinase-associated lipocalin (NGAL) is overexpressed in renal tubules during ischemia and inflammation. Both plasma and urinary NGAL levels have a strong prognostic value for renal impairment and are associated with an increased probability for renal replacement therapy institution. Cystatin C is increased during the early and milder stages of tubular damage, while kidney damage molecule-1 (ΚΙΜ-1) increases in ischemia and nephrotoxic damage and appears to play a similar role to NGAL in S-AKI detection. Tissue metalloproteinase-2 inhibitor and insulin-like growth factor-7 binding protein increase in tubular cells when their DNA is damaged. The product of the two biomarkers has the highest diagnostic value in S-AKI detection of all the biomarkers studied so far. Prevention of S-AKI is often impossible. Early and specific use of antibiotics together with the treatment of sepsis reduces the risk of developing S-AKI. Adequate fluid intake appears to improve renal function although opinions differ. The use of balanced crystalline solutions and avoidance of synthetic colloids is recommended. Norepinephrine is the drug of choice for the treatment of septic shock, while angiotensin II shows promising results.

47-70

Authors: Grosomanidis V, Fyntanidou B, Gkarmiri S, Theodosiadis P, Kazakos G , Kyparissa M,Pertsikapa M, Kotzampassi K.

Increased Intraabdominal Pressure (IAP) is common in critical care patients and has detrimental effects on organs and systems. Several mechanisms and causes are involved in its pathogenesis. The aim of the present study was to investigate and record IAP effects alone and in combination with sepsis on respiratory mechanics. Sixteen male pigs were included in the study, which were randomized in two groups of 8 pigs (Group A & B). After baseline measurements, IAP increased in both groups by Helium insufflation to 25mmHg and remained elevated throughout the study period. In Group B, sepsis was induced after 60min by intravenous lipopolysaccharide (LPS) administration. Recorded parameters included PIPAW, PIPES, EIPAW, EIPES, PmeanAW, PmeanES, PEEPAW, PEEPES, CRS, CCW, CL, RinspRS, RexpRS RinspCW, RexpCW, Vexp and were measured at baseline and every 20min for 3hrs. Airway pressures in Group A (PIPAW, EIPAW, PmeanAW) increased after IAP elevation but returned to their baseline values after IAP normalization. In Group B airway pressures increased even further after LPS administration and decreased after IAP normalization but they never reached their baseline values. On the contrary esophageal pressures (PIPES, EIPES, PmeanES) showed similar alterations in both groups. PEEP did not change in any of the study groups. Respiratory system compliance decreased in both groups and returned to baseline values only in Group A. Chest wall compliance showed similar alterations in both groups. Lung compliance decreased after IAP increase in both groups and showed a further decrease after LPS administration in Group B, which remained after IAP normalization. Respiratory system inspiratory resistances increased only in Group B, whereas respiratory system expiratory resistances increased in both groups. Chest wall inspiratory resistances did not show any alterations. Our study results showed that the effects of IAP increase are reversible, whereas the effects of coexisting sepsis remain even after IAP normalization

76-81

Authors: Papadopoulou D, Diagoupi A, Trantzas P, Paraskevopoulos T, Bairaktari A

We present the case of a 64-year old super-obese female who underwent Open Reduction Internal Fixation (ORIF) for proximal humeral fracture, and our anaesthetic management. We performed interscalene brachial plexus block prior to induction, and general anaesthesia, following the guidelines for difficult airway. What is interesting about this case, are the technical difficulties that often arise in such obese individuals, concerning both the peripheral nerve block and the airway management. Moreover, due to those difficulties we created a systematic management plan consistent with guidelines so as to minimize the failure risk.