…why remifentanil?

…why remifentanil? Journal of Anesthesia (2018) 32:458 https://doi.org/10.1007/s00540-018-2488-6 LE T TER TO  THE   EDITOR Guillermo Lema Received: 21 January 2018 / Accepted: 20 March 2018 / Published online: 28 March 2018 © Japanese Society of Anesthesiologists 2018 To the Editor: (4) In the analysis described, only patients with normal I would like to make some comments to the manuscript plasma creatinine were studied. In those groups, the by Waturu Sakai et al. [1]. chance of finding “one factor” that may have incidence on AKI is almost impossible. (1) The authors make a big effort analyzing retrospec - (5) AKI during cardiac surgery with CPB has been strongly tively their database. They choose to study the effects studied in the last 60 years. So far, many factors have of remifentanil in the incidence of renal damage (AKI) been associated to renal failure: changes in tempera- during cardiac surgery (valve procedures) with cardio- ture, hemoglobin, hemodilution, nonpulsatile flow, pulmonary bypass (CPB). systemic inflammatory reaction, perfusion pressure, (2) In the introduction, they mention the reasons why hemodynamic alteration pre- and post-bypass, vasoac- remifentanil may have benefits during CPB. However, tive drugs, nephrotoxic drugs, CPB time, among many those benefits do not necessarily link to the develop - others. However, to my knowledge, no anesthetics ment of AKI under the studied conditions. drugs have been considered among those factors as yet. (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 Reference anesthetics, old and new, intravenous or halogenated 1. Saakai W, Yoshikawa Y, Hirata N, Yamakage M. Effect of agents including remifentanil, have been deeply and remifentanil during cardiopulmonary bypass on incidence of acute extensively studied, and no association with AKI has kidney injury after cardiac surgery. J Anesth. 2017;31:895–902. been found in different types of surgical procedures. This comment refers to the article available at https ://doi. org/10.1007/s0054 0-017-2419-y. * Guillermo Lema glema@med.puc.cl Pontificia Universidad Catolica de Chile, Santiago, Chile Vol:.(1234567890) 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Anesthesia Springer Journals

…why remifentanil?

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Publisher
Springer Japan
Copyright
Copyright © 2018 by Japanese Society of Anesthesiologists
Subject
Medicine & Public Health; Anesthesiology; Pain Medicine; Intensive / Critical Care Medicine; Emergency Medicine
ISSN
0913-8668
eISSN
1438-8359
D.O.I.
10.1007/s00540-018-2488-6
Publisher site
See Article on Publisher Site

Abstract

Journal of Anesthesia (2018) 32:458 https://doi.org/10.1007/s00540-018-2488-6 LE T TER TO  THE   EDITOR Guillermo Lema Received: 21 January 2018 / Accepted: 20 March 2018 / Published online: 28 March 2018 © Japanese Society of Anesthesiologists 2018 To the Editor: (4) In the analysis described, only patients with normal I would like to make some comments to the manuscript plasma creatinine were studied. In those groups, the by Waturu Sakai et al. [1]. chance of finding “one factor” that may have incidence on AKI is almost impossible. (1) The authors make a big effort analyzing retrospec - (5) AKI during cardiac surgery with CPB has been strongly tively their database. They choose to study the effects studied in the last 60 years. So far, many factors have of remifentanil in the incidence of renal damage (AKI) been associated to renal failure: changes in tempera- during cardiac surgery (valve procedures) with cardio- ture, hemoglobin, hemodilution, nonpulsatile flow, pulmonary bypass (CPB). systemic inflammatory reaction, perfusion pressure, (2) In the introduction, they mention the reasons why hemodynamic alteration pre- and post-bypass, vasoac- remifentanil may have benefits during CPB. However, tive drugs, nephrotoxic drugs, CPB time, among many those benefits do not necessarily link to the develop - others. However, to my knowledge, no anesthetics ment of AKI under the studied conditions. drugs have been considered among those factors as yet. (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 Reference anesthetics, old and new, intravenous or halogenated 1. Saakai W, Yoshikawa Y, Hirata N, Yamakage M. Effect of agents including remifentanil, have been deeply and remifentanil during cardiopulmonary bypass on incidence of acute extensively studied, and no association with AKI has kidney injury after cardiac surgery. J Anesth. 2017;31:895–902. been found in different types of surgical procedures. This comment refers to the article available at https ://doi. org/10.1007/s0054 0-017-2419-y. * Guillermo Lema glema@med.puc.cl Pontificia Universidad Catolica de Chile, Santiago, Chile Vol:.(1234567890) 1 3

Journal

Journal of AnesthesiaSpringer Journals

Published: Mar 28, 2018

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