Kardiyopulmoner Baypas Kullanılarak Kardiyak Cerrahi Geçiren Erişkin Hastalarda İntraoperatif Remifentanil veya Deksmedetomidin Kullanımının Renal Etkilerinin Karşılaştırılması

Abstract

Background: Acute kidney injury (AKI) is one of the most important causes of postoperative morbidity and mortality in cardiovascular surgery. In these patients; metabolic factors, exogenous and endogenous toxins, ischemia-reperfusion injury, cellular and systemic inflammation and oxidative stress are held responsible for renal damage. Dexmedetomidine or remifentanil are routinely used drugs to provide intraoperative analgesia following induction of anesthesia during cardiopulmonary bypass. Various studies show evidence of a renal protective effect of dexmedetomidine. The aim of our study is to investigate the effects of dexmedetomidine or remifentanil use on the development of postoperative AKI in patients undergoing cardiovascular surgery. Materials and Methods: A total of 210 adult patients who underwent cardiopulmonary bypass surgery in our center between January 01, 2021 and January 01, 2022 were included in the study. In addition to the baseline demographic and clinical data of the patients, the agents used in the intraoperative period, anesthesia duration, aortic cross clamp duration, cardiopulmonary bypass time, use of blood products, amount of fluid taken and removed, and creatinine monitoring for 7 days postoperatively were analyzed retrospectively. The effects of dexmedetomidine (n=105) or remifentanil (n=105) use on the development of postoperative AKI were investigated using statistical methods. Results: The mean age of the patients [111 (52.9%) men and 99 (47.1%) women] was 58.5±14.7 years. The incidence of postoperative AKI was 16.2% (34 patients). In a median follow-up period of 20 (0-29) months, the postoperative AKI increased the risk of death 13.5 times. While the rate of postoperative AKI was 8.6% in patients receiving dexmedetomidine, this rate was 23.8% in patients receiving remifentanil. In multiple logistic regression analysis, age ≥65 years, preoperative hemoglobin level <10 g/dl, intraoperative; furosemide and noradrenaline were found to be individually independent risk factors for the the development of postoperative AKI, use of dexmedetomidine was found to be an independent protective factor. Conclusion: Our study showed that, the postoperative AKI is common in adults undergoing cardiac surgery and significantly affects mortality. Evidence has been provided that the use of dexmedetomidine for intraoperative maintenance analgesia may reduce the risk of postoperative AKI in this group. In addition, it was determined that the age of 65 and over, preoperative hemoglobin level <10 g/dl, and intraoperative furosemide or noradrenaline administrations increased the risk of postoperative AKI.