A Review of Anesthetic Effects on Renal Function: Potential Organ Protection

Abstract

Background: Renal protection is a critical concept for anesthesiologists, nephrologists, and urologists, since anesthesia and renal function are highly interconnected and can potentially interfere with one another. Therefore, a comprehensive understanding of anesthetic drugs and their effects on renal function remains fundamental to the success of renal surgeries, especially transplant procedures. Some experimental studies have shown that some anesthetics provide protection against renal ischemia/reperfusion (IR) injury, but there is limited clinical evidence. Summary: The effects of anesthetic drugs on renal failure are particularly important in the context of kidney transplantation, since the conditions of preservation following removal profoundly influence the recovery of organ function. Currently, preservation procedures are typically based on the usage of a cold-storage solution. Some anesthetic drugs induce anti-inflammatory, anti-necrotic, and anti-apoptotic effects. A more thorough understanding of anesthetic effects on renal function can present a novel approach for developing organ-protective strategies. The aim of this review is to discuss the effects of different anesthetic drugs on renal function, with particular focus on IR injury. Many studies have demonstrated the organ-protective effects of some anesthetic drugs, specifically propofol, which indicate the potential of some anesthetics to introduce novel organ protective targets. This is not surprising, since lipid emulsions are major components of propofol, which accumulating data show provide organ protective effects against IR injury. Key Messages: Thorough understanding of the interaction between anesthetic drugs and renal function remains fundamental to the delivery of safe perioperative care and to optimizing outcomes after renal surgeries, particularly transplant procedures. Anesthetics can be repurposed for organ protection with more information about their effects, especially during transplant procedures. Here, we review the effects of different anesthetic drugs – specifically those that contain lipids in their structure, with special reference to IR injury.

“Anesthesia Stat” to Intubate a Coronavirus Disease 2019 (COVID-19) Patient: Implications for the Anesthesiologist

“…12 Benzodiazepines should be used cautiously in patients with renal disease because they have been associated with a higher risk of AKI in intensive care unit patients. 13 Midazolam could serve as a good induction agent for COVID-19 intubations because of its fast onset of action and hemodynamic profile.…”

“…An animal study demonstrated that ketamine attenuated renal inflammation seen with hypoxia. 13 In sepsis or septic shock, ketamine can be protective against inflammation, reduce nitric oxide production, and decrease cardiac dysfunction, all of which prevent hemodynamic instability. 12 Ketamine could be a good agent for COVID-19 patient inductions; however, the anesthesiologist must be wary of cardiac failure with induction doses, especially if there is any pre-existing history of cardiac disease or concern for viral cardiomyopathy.…”

Study of Some Health Hazards among Operating Theater Personnel Due to Exposure to Anesthetic Gases (II)

“…The direct effects of anesthesia which are dose and agent-dependent include effects on auto regulation of renal blood flow, alteration in the effect of anti diuretic hormone (ADH), and effects on tubular transport of sodium and organic acids (Burchardi and Kaczmarczyk, 1994). Some anesthetic drugs induce anti-inflammatory, antinecrotic, and anti-apoptotic effects on renal tissue (Motayagheni et al, 2017). Researchers found that isoflurane provides preconditioning protective effects through anti-inflammatory and anti-apoptotic actions in a rat model (kim et al, 2013).…”

The Impact of Propofol- and Inhalant-Based Anesthesia on Acute Kidney Injury After Major Abdominal Surgery: A Retrospective Observational Study

“…(9,10) Notably, some anesthetics have antioxidant and/or anti-in ammatory properties. (11)(12)(13)(14) Propofol was shown to reduce susceptibility to oxidative stress and tissue injury in an in vitro animal study. (11) Another recent study reported that sevo urane had both immunomodulatory and renoprotective effects after liver transplantation in rat models.…”