Journal of Anesthesia (2018) 32:458
LETTER TO THE EDITOR
Received: 21 January 2018 / Accepted: 20 March 2018 / Published online: 28 March 2018
© Japanese Society of Anesthesiologists 2018
To the Editor:
I would like to make some comments to the manuscript
by Waturu Sakai et al. .
(1) The authors make a big eﬀort analyzing retrospec-
tively their database. They choose to study the eﬀects
of remifentanil in the incidence of renal damage (AKI)
during cardiac surgery (valve procedures) with cardio-
pulmonary bypass (CPB).
(2) In the introduction, they mention the reasons why
remifentanil may have beneﬁts during CPB. However,
those beneﬁts do not necessarily link to the develop-
ment of AKI under the studied conditions.
(3) To my knowledge, only two anesthetics have been
associated with renal failure: enﬂurane and metoxiﬂu-
rane. Both oﬀ the market for more than 50 years. All
anesthetics, old and new, intravenous or halogenated
agents including remifentanil, have been deeply and
extensively studied, and no association with AKI has
been found in diﬀerent types of surgical procedures.
(4) In the analysis described, only patients with normal
plasma creatinine were studied. In those groups, the
chance of ﬁnding “one factor” that may have incidence
on AKI is almost impossible.
(5) AKI during cardiac surgery with CPB has been strongly
studied in the last 60 years. So far, many factors have
been associated to renal failure: changes in tempera-
ture, hemoglobin, hemodilution, nonpulsatile flow,
systemic inﬂammatory reaction, perfusion pressure,
hemodynamic alteration pre- and post-bypass, vasoac-
tive drugs, nephrotoxic drugs, CPB time, among many
others. However, to my knowledge, no anesthetics
drugs have been considered among those factors as yet.
1. Saakai W, Yoshikawa Y, Hirata N, Yamakage M. Effect of
remifentanil during cardiopulmonary bypass on incidence of acute
kidney injury after cardiac surgery. J Anesth. 2017;31:895–902.
This comment refers to the article available at https ://doi.
* Guillermo Lema
Pontiﬁcia Universidad Catolica de Chile, Santiago, Chile