Anesthesia for Patients with Ventricular Assist Devices
Wayne E. Richenbacher in Mechanical Circulatory Support, 2020
Patients supported with an LVAD may require inotropes prior to coming off CPB (Table 8.2). Systemic vasodilation may be a problem in this situation if the left atrial pressure is normal and systemic blood pressure low. Administration of moderate doses of norepinephrine bitartrate (0.05–0.1 μg/kg IV) may be necessary and on occasion more than one inotrope may be needed. If right ventricular dysfunction is present, but not severe enough to require an RVAD, administration of amrinone lactate or doubtamine hydrochloride may improve right ventricular function. Bleeding and coagulopathy is a concern after LVAD placement. Packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets are often necessary. Hemofiltration may be used after the patient has been weaned from CPB. Hemofiltration decreases third space fluid accumulation and reduces the potential for pulmonary and other complications related to interstitial edema. Reversal of heparin sodium is performed once hemodynamic stability is achieved after CPB has been discontinued. A test dose of protamine sulfate is administered and if no reaction occurs the full dose of protamine sulfate is slowly given.
Pharmacology of azole antifungal agents
Mahmoud A. Ghannoum, John R. Perfect in Antifungal Therapy, 2019
The effect of organ dysfunction on drug elimination has been studied with each of the azole agents. Renal dysfunction is a concern for patients receiving fluconazole. In patients with renal dysfunction, it is advised to decrease the total daily dose of fluconazole by 50% [26]. Studies have also been conducted in patients requiring renal replacement therapy with either hemodialysis or continuous hemofiltration. For a traditional hemodialysis session, 25%–40% of fluconazole is removed depending on the duration of the session [91,92]. Therefore, supplementation is suggested following each dialysis session [26]. Continuous hemofiltration increased clearance of fluconazole ranging from 20 to 400 times baseline elimination in patients with acute renal failure suggesting that daily dosing should be continued in this population [93].
Extracorporeal life support for neonatal cardiorespiratory failure
Prem Puri in Newborn Surgery, 2017
Infants on ECMO may sustain acute kidney injury (AKI) marked by oliguria and increasing BUN and creatinine levels. A single-center study from the Netherlands published in 2013 reported that two-thirds of neonates who required ECMO sustained AKI.24 The authors observed significantly lower survival in those babies whose RIFLE score was “F” (failure of kidney function) and concluded that, since AKI in childhood may predispose to chronic kidney disease in adulthood, all infants who develop AKI while on ECMO should receive long-term monitoring of kidney function. The mechanism of AKI is likely multifactorial and includes both inadequate organ perfusion associated with the need for ECMO and effects of the circuit. The authors of the Netherlands study observed that the severity of AKI was greatest in the first 2 days of ECMO support. Both hemofiltration and hemodialysis have been used in conjunction with ECMO support and may help manage fluid volume status and electrolyte abnormalities.
Diagnosis and management of tumor lysis syndrome.
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Isha Puri, Deep Sharma, Krishna S. Gunturu, Andaleeb A. Ahmed
A. Hyperkalemia. It is the most life-threatening electrolyte abnormality due to the risk of fatal cardiac arrhythmias. Continuous telemetryFrequent monitoring of serum potassium (every 4–6 hours)Avoid exogenous potassium intakePotassium lowering agents (Patiromer, & sodium polystyrene sulfonate)Administration of IV Insulin-Glucose, and inhaled beta-agonists (albuterol)IV Calcium administration to prevent cardiac arrythmias.Hemodialysis or hemofiltration.
Continuous extracorporeal clearance in metformin-associated lactic acidosis and metformin-induced lactic acidosis: a systematic review
Published in Clinical Toxicology, 2022
Matthew S. Correia, B. Zane Horowitz
CKRT/CRRT is not a single modality but may refer to hemofiltration (CVVH), hemodialysis (CVVHD), or hemodiafiltration (CVVHDF). Hemofiltration uses convection to clear solutes as compared to diffusion in hemodialysis. This is a subtly different process whereby solutes travel across a semipermeable membrane via bulk flow along with the solvent (i.e., water within the patient’s blood) rather than down a concentration gradient. The driving force for the bulk flow is hydrostatic pressure – blood is at a higher pressure than the ultrafiltrate (effluent). Net fluid that is eliminated by ultrafiltration may be replaced prior to blood return if absolute fluid removal is not desired. Mechanistically, CVVHD functions similarly to intermittent hemodialysis however at much lower flow rates.
From pathogenesis to novel therapies in primary hyperoxaluria
Published in Expert Opinion on Orphan Drugs, 2019
Gill Rumsby, Sally-Anne Hulton
HD or continuous renal replacement therapy may be required following isolated liver transplantation where sequential hepatorenal transplantation is being undertaken, or following combined transplantation where there is delayed graft function. In these circumstances, the benefit of intra-operative dialysis is considered too risky due to the anticoagulation required but immediate postoperative hemofiltration is necessary in patients with significant systemic involvement where the urine volume is reduced. Dialysis in these circumstances will produce a rapid fall in plasma oxalate thus protecting the transplanted kidney from tubulotoxic effects and oxalate deposition, as long as the risk of calcium oxalate supersaturation is avoided with accurate fluid management [41,49].
Related Knowledge Centers
- Acute Kidney Injury
- Renal Replacement Therapy
- Semipermeable Membrane
- Ultrafiltration
- Blood
- Multiple Organ Dysfunction Syndrome
- Sepsis
- Intensive Care Medicine
- Kidney Dialysis
- Solution