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Intraoperative Considerations to Prevent Postoperative Acute Kidney Injury

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Perioperative Kidney Injury

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Abstract

The diagnosis of perioperative acute kidney injury (AKI) carries with it an increased risk for significant morbidity and mortality. Once a patient has been identified as high risk for postoperative AKI, careful planning to include hemodynamic optimization, relief of anemia, and avoidance of nephrotoxic drugs should be undertaken along with consideration of employing minimally invasive surgical techniques. During the intraoperative period, most of the management of the patient at risk for AKI revolves around providing an adequate hemodynamic state. This can be achieved by monitoring various indices of cardiac performance, which can guide the selection and proper balance of fluids and vasoactive medications to achieve a goal-directed therapy. Strategies aimed at avoiding blood loss, with careful use of antifibrinolytics and blood salvage techniques, could be beneficial. Intraoperative exposure to known nephrotoxic agents should be avoided in those patients at higher risk of AKI.

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  1. Department of Anesthesiology, Yale New Haven Hospital, Yale University School of Medicine, 333 Cedar Street, T#3, New Haven, CT, 06510-3206, USA

    Susan Garwood MBChB

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Correspondence to Susan Garwood MBChB .

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  1. Division of Nephrology and Hypertension, University of Cincinnati, Cincinnati, Ohio, USA

    Charuhas V. Thakar

  2. Program of Applied Translational Research, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA

    Chirag R. Parikh

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Garwood, S. (2015). Intraoperative Considerations to Prevent Postoperative Acute Kidney Injury. In: Thakar, C., Parikh, C. (eds) Perioperative Kidney Injury. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1273-5_6

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