BackgroundSeveral studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, against matched controls.MethodsPatients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls that were matched (1:1) for age, gender and presence or absence of diabetes or hypertension. The eGFR was calculated from creatinine values according to the ‘modification of diet in renal disease study’ (MDRD) formula and was compared between cases and controls. A meta-analysis was performed to compare our findings with similar studies in literature.ResultsForty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly lower (p = 0.04) compared to controls. This difference persisted between the subgroup of lithium users without comorbidities (diabetes and hypertension) and their controls but disappeared for lithium users with comorbidities and their controls. Nonetheless, lithium users had lower eGFR values in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference -10.3 ml/min (95% confidence interval: -15.13 to -5.55, p < 0.0001)].ConclusionsLithium causes a subtle decline in glomerular filtration rate; renal function needs to be monitored in patients on lithium treatment.

Background: Several studies have shown that long-term lithium use is associated with a subtle decline in estimated glomerular filtration rate. This study compared mean estimated glomerular filtration rates (eGFR) in patients on long term lithium, against matched controls. Methods: Patients with bipolar affective disorder, who are on lithium (for at least a year), were compared against controls that were matched (1:1) for age, gender and presence or absence of diabetes or hypertension. The eGFR was calculated from creatinine values according to the 'modification of diet in renal disease study' (MDRD) formula and was compared between cases and controls. A meta-analysis was performed to compare our findings with similar studies in literature. Results: Forty seven patients met the inclusion criteria. They were matched with 47 controls. The eGFR values of lithium users were significantly lower (p = 0.04) compared to controls. This difference persisted between the subgroup of lithium users without comorbidities (diabetes and hypertension) and their controls but disappeared for lithium users with comorbidities and their controls. Nonetheless, lithium users had lower eGFR values in both subgroups. A meta-analysis of 9 studies showed a significant lowering in the glomerular filtration rate in lithium users compared to controls [mean difference −10.3 ml/min (95% confidence interval: -15.13 to −5.55, p < 0.0001)]. Conclusions: Lithium causes a subtle decline in glomerular filtration rate; renal function needs to be monitored in patients on lithium treatment.

The coronavirus disease-2019 (COVID-19) pandemic has raised many concerns regarding the safety of patients and healthcare workers. Anaesthetic implications and the impact of this pandemic on anaesthesiologists have been discussed widely in the recent past. Operating theatres are high-risk areas where anaesthesiologists perform various aerosolgenerating procedures (AGPs).Prolong patient contact predisposes them to the risk of exposure. Scarcity of resources and limitations in testing pose an additional risk to the anesthesiologist. Although guidance from various professional bodies is in abundance, there is a general lack of consensus. This review summarises current evidence and guidelines related to anaesthesiology during the COVID-19 pandemic. Ensuring the provision of unhindered care, ensuring patient safety and protecting oneself with optimum utilization of available resources remain a challenge to the anesthesiologist.