Franzén Stephanie, Frithiof Robert, Hultström Michael
Department of Surgical Sciences, Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden.
Am J Physiol Renal Physiol. 2023 Apr 1;324(4):F329-F334. doi: 10.1152/ajprenal.00316.2022. Epub 2023 Feb 16.
Postoperative acute kidney injury (AKI) is a common complication after surgery. The pathophysiology of postoperative AKI is complex. One potentially important factor is anesthetic modality. We, therefore, conducted a meta-analysis of the available literature regarding anesthetic modality and incidence of postoperative AKI. Records were retrieved until January 17, 2023, with the search terms ("propofol" OR "intravenous") AND ("sevoflurane" OR "desflurane" OR "isoflurane" OR "volatile" OR "inhalational") AND ("acute kidney injury" OR "AKI"). A meta-analysis for common effects and random effects was performed after exclusion assessment. Eight records were included in the meta-analysis with a total of 15,140 patients ( = 7,542 propofol and = 7,598 volatile). The common and random effects model revealed that propofol was associated with a lower incidence of postoperative AKI compared with volatile anesthesia [odds ratio: 0.63 (95% confidence interval: 0.56-0.72) and 0.49 (95% confidence interval: 0.33-0.73), respectively]. In conclusion, the meta-analysis revealed that propofol anesthesia is associated with a lower incidence of postoperative AKI compared with volatile anesthesia. This may motivate choosing propofol-based anesthesia in patients with increased risk of postoperative AKI due to preexisting renal impairment or surgery with a high risk of renal ischemia. This study analyzed the available literature on anesthetic modality and incidence of postoperative AKI. The meta-analysis revealed that propofol is associated with lower incidence of AKI compared with volatile anesthesia. It might therefore be considerable to use propofol anesthesia in surgeries with increased susceptibility for developing renal injuries such as cardiopulmonary bypass and major abdominal surgery.
术后急性肾损伤（AKI）是手术后常见的并发症。术后AKI的病理生理学很复杂。一个潜在的重要因素是麻醉方式。因此，我们对有关麻醉方式与术后AKI发生率的现有文献进行了荟萃分析。检索记录截至2023年1月17日，检索词为（“丙泊酚”或“静脉注射”）且（“七氟醚”或“地氟醚”或“异氟醚”或“挥发性”或“吸入性”）且（“急性肾损伤”或“AKI”）。在排除评估后进行了固定效应和随机效应的荟萃分析。八项记录纳入荟萃分析，共有15140例患者（丙泊酚组n = 7542，挥发性麻醉组n = 7598）。固定效应模型和随机效应模型均显示，与挥发性麻醉相比，丙泊酚与术后AKI发生率较低相关[优势比分别为：0.63（95%置信区间：0.56 - 0.72）和0.49（95%置信区间：0.33 - 0.73）]。总之，荟萃分析显示，与挥发性麻醉相比，丙泊酚麻醉与术后AKI发生率较低相关。这可能促使在因既往肾功能损害或肾缺血风险高的手术而术后AKI风险增加的患者中选择丙泊酚为基础的麻醉。本研究分析了有关麻醉方式与术后AKI发生率的现有文献。荟萃分析显示，与挥发性麻醉相比，丙泊酚与AKI发生率较低相关。因此，在诸如体外循环和腹部大手术等发生肾损伤易感性增加的手术中使用丙泊酚麻醉可能是值得考虑的。
