Yoon Soo-Hyuk, Kim Yoon Jung, Seo Jeong-Hwa, Lim Hanbyeol, Lee Ho-Jin, Kwak Cheol, Kim Won Ho, Yoon Hyun-Kyu
Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Anaesthesia. 2025 Mar;80(3):278-287. doi: 10.1111/anae.16490. Epub 2024 Nov 26.
Acute kidney injury develops frequently after nephrectomy, causing increased hospital duration of stay and mortality. Both propofol and volatile anaesthetic agents are thought to have renoprotective effects. We investigated whether the type of maintenance anaesthetic (propofol or desflurane) affected the incidence of acute kidney injury after nephrectomy.
This single-centre, randomised controlled trial enrolled adult patients with renal cell carcinoma undergoing nephrectomy. In patients allocated to the propofol group, anaesthesia was induced and maintained using a target-controlled infusion of propofol. In patients allocated to the desflurane group, anaesthesia was induced with a bolus of thiopental and maintained with desflurane. Both groups received a target-controlled infusion of remifentanil during surgery. The primary outcome was the incidence of acute kidney injury within 7 postoperative days based on the serum creatinine component of the Kidney Disease: Improving Global Outcomes criteria.
We analysed 317 patients (median (IQR [range]) age 62 (52-70 [26-85] y); 221 (70%) men). Postoperative AKI developed in 79 (25%) patients: 43 (27%) in the propofol group and 36 (23%) in the desflurane group (absolute risk difference (95%CI) 4.6 (-4.9-14.0%), p = 0.347). The severity of kidney injury was stage 1 in 76 patients, stage 2 in two patients and stage 3 in one patient.
The type of anaesthetic maintenance drug (propofol vs. desflurane) did not affect the incidence of acute kidney injury after nephrectomy. Future research might be better directed towards investigating other potentially modifiable risk factors for postoperative acute kidney injury in this patient population.
肾切除术后急性肾损伤频繁发生，导致住院时间延长和死亡率增加。丙泊酚和挥发性麻醉剂都被认为具有肾脏保护作用。我们研究了维持麻醉的类型（丙泊酚或地氟醚）是否会影响肾切除术后急性肾损伤的发生率。
这项单中心随机对照试验纳入了接受肾切除术的成年肾细胞癌患者。分配到丙泊酚组的患者，采用丙泊酚靶控输注诱导和维持麻醉。分配到地氟醚组的患者，用硫喷妥钠推注诱导麻醉，用地氟醚维持麻醉。两组在手术期间均接受瑞芬太尼靶控输注。主要结局是根据改善全球肾脏病预后组织标准中血清肌酐成分确定的术后7天内急性肾损伤的发生率。
我们分析了317例患者（年龄中位数（IQR[范围]）为62岁（52 - 70[26 - 85]岁）；221例（70%）为男性）。79例（25%）患者发生了术后急性肾损伤：丙泊酚组43例（27%），地氟醚组36例（23%）（绝对风险差异（95%CI）4.6（-4.9 - 14.0%），p = 0.347）。肾损伤严重程度为1期的有76例患者，2期的有2例患者，3期的有1例患者。
麻醉维持药物的类型（丙泊酚与地氟醚）不影响肾切除术后急性肾损伤的发生率。未来的研究可能更好地致力于调查该患者群体术后急性肾损伤的其他潜在可改变的危险因素。
