PurposeTo assess Cyclosporine A (CsA) therapy at an intraperitoneal dose of 15 mg.kg
-1 in a rodent model of non-septic renal ischemia.MethodsTwenty male Wistar rats were randomized to receive CsA therapy or none
therapy before undergoing 30 minutes of renal ischemia followed by
reperfusion. Additionally, 10 rats were randomized to undergo the same
surgical procedure of the aforementioned animals with neither ischemia nor
CsA therapy. Twelve hours after kidney ischemia, the left kidneys were
evaluated for histological injury according to Park’s criteria. Serum
creatinine (Cr), urea nitrogen (Ur) and sodium levels were obtained at
different times of the experimental protocol.ResultsRodents in the CsA group showed negative results (p<0.05) in serum
variables (Cr: 0.41±0.05mg/dL vs . 4.17±1.25mg/dL; Ur:
40.90±3.98mg/dL vs . 187.70±22.93mg/dL) even the non CsA or
control group (Cr: 0.35±0.07mg/dL vs . 3.80±1.20mg/dL; Ur:
40.10±4.70mg/dL vs . 184.50±49.80mg/dL). The negative
results were also verified in histological evaluation, CsA group had 50% in
the very severe grade of lesion, 10% in the severe and 40% in the moderate
to severe whereas the control group had 90% in the very severe grade.ConclusionCsA was incapable of preventing the deleterious effects of
ischemia-reperfusion injury in rat kidneys.
Preoperative evaluation in elective surgeries has been associated with successful surgical treatment. However, there is no solid scientific evidence that screening for coronary artery disease (CAD) reduces surgical risk. The aims of this study were to describe the frequency of inappropriate investigation of obstructive CAD induced by pre-anesthetic assessment in individuals without cardiovascular symptoms (candidates for low-to intermediate-risk surgeries) and to evaluate predictors of this conduct. We performed a retrospective evaluation of medical records of anesthesiology services from patients undergoing preanesthesia assessment between May 2015 and May 2016, including those with functional capacity X4 metabolic equivalents without a diagnosis of heart disease. A total of 778 medical records (47 ± 16 years of age, 62.6% female) were studied. A private hospital performed 50.1% of the surgeries and 60.4% were of intermediate risk. Only 2.7% (95%CI: 1.7-4.1%) were screened for CAD, and 91% of these requests were mediated by cardiology consultations performed during pre-anesthetic testing visits. Factors associated with screening for CAD were hypertension, diabetes, moderate systemic disease (ASA III), cardiac consultation, previous diagnosis of CAD, and admission to a private hospital. Independent predictors were private hospitals (OR: 3.9; 95%CI: 1.3-11.0), ASA III (OR: 5.3; 95%CI: 1.7-16.2), and hypertension (OR: 3.8; 95%CI: 1.5-9.8). The frequency of inappropriate requests for CAD screening in asymptomatic individuals without untreated systemic diseases was low in pre-anesthetic visits. Although infrequent, screening for CAD is more common in the private setting, in patients with poorer health status, and is usually prescribed during cardiology consultation.
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