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Query: UMLS:C0002871 (anemia)
 52,094 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Anaemia, hypoproteinaemia and acidic pH in renal failure patients can alter the pharmacokinetics and pharmacodynamics of anaesthetic agents, resulting in altered dose requirements. We evaluated the induction dose of propofol in adult patients with end-stage renal disease by titrating the hypnotic effect by means of a clinical parameter as well as using a more objective assessment of hypnosis, the Bispectral Index (BIS) monitor. The dose was compared with that for patients with normal renal function. Propofol doses that provided the clinical end-point of hypnosis (syringe drop method), as well as the end-point of a mean (SD) BIS value of 50 (5), were evaluated in 27 end-stage renal disease and 27 normal renal function patients. Propofol was administered at 0.2 mg/kg every 15 seconds until these end-points were achieved. End-stage renal disease patients required significantly higher propofol doses to achieve the clinical end-point of hypnosis (1.42 (0.24) mg/kg versus 0.89 (0.2) mg/kg in normal renalfunction patients, P<0.05 unpaired "t" test). Propofol dose required to achieve a BIS of 50 (5) was also higher in end-stage renal disease patients (2.03 (0.4) mg/kg versus 1.39 (0.43) mg/kg in normal renal function patients, P<0.05). There was a significant negative correlation of propofol dose with preoperative haemoglobin concentration. A hyperdynamic circulation in renal failure patients with anaemia may be responsible for the higher propofol dose requirement in this group.
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PMID:Evaluation of induction doses of propofol: comparison between endstage renal disease and normal renal function patients. 1241 56

In the last years the increasing of diabetes and hypertension has produced a considerable increase of patients with chronic renal failure; secondary hyperparathyroidism is one of the major complications. The resection of hyperfunctioning parathyroid tissue is the ultimate goal of the treatment. The preoperative examination by the anesthetist is the starting-point of the treatment. The anesthetist programs hemodialysis, the correction of fluid and electrolyte abnormalities and of the anaemia. In the operating room the anesthetist is involved in the careful monitoring of liquid infusion and anesthesiological procedure. The intraoperative parathyroid hormone (PTH) assay is an essential tool because the stress of orotracheal intubation elicits the raising of the catecholamine levels, and the catecholamines stimulates PTH secretion. Propofol can interfere with the intraoperative PTH assay causing an artificial reduction of PTH levels. This study highlights the difficulty in the application of anesthesiological protocol in the uremic patient.
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PMID:[The role of the anesthesiologist in secondary hyperparathyroidism]. 2064 88