Anesthesia and the renal sympathetic nervous system in perioperative AKI

Franzén, Stephanie; DiBona, Gerald F.; Frithiof, Robert

doi:10.1016/j.semnephrol.2022.10.009

Cited by 6 publications

(6 citation statements)

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“…The finding that the renal sympathetic activity is blunted during the course of exposure to AIH under volatile anesthesia might also have clinical implications. RSNA has been proved to be important in the perioperative period and is known to be independently affected by volatile anesthetics [48]. Thus far, most studies have demonstrated an increase in RSNA in animals anesthetized with volatile anesthetics [31,37,48], whereas our study indicates the RSNA was blunted by volatile anesthetics, albeit in the environmental setting of AIH.…”

Section: Discussioncontrasting

confidence: 46%

“…RSNA has been proved to be important in the perioperative period and is known to be independently affected by volatile anesthetics [48]. Thus far, most studies have demonstrated an increase in RSNA in animals anesthetized with volatile anesthetics [31,37,48], whereas our study indicates the RSNA was blunted by volatile anesthetics, albeit in the environmental setting of AIH. The changes in the renal blood flow evoked by modifications in RSNA can have a profound impact on kidney excretory function and oxygenation and could contribute to the development of acute kidney injury in the perioperative setting [48].…”

Section: Discussioncontrasting

confidence: 46%

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The Effects of Volatile Anesthetics on Renal Sympathetic and Phrenic Nerve Activity during Acute Intermittent Hypoxia in Rats

Krnić,

Madirazza,

Pecotić

et al. 2024

Biomedicines

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Coordinated activation of sympathetic and respiratory nervous systems is crucial in responses to noxious stimuli such as intermittent hypoxia. Acute intermittent hypoxia (AIH) is a valuable model for studying obstructive sleep apnea (OSA) pathophysiology, and stimulation of breathing during AIH is known to elicit long-term changes in respiratory and sympathetic functions. The aim of this study was to record the renal sympathetic nerve activity (RSNA) and phrenic nerve activity (PNA) during the AIH protocol in rats exposed to monoanesthesia with sevoflurane or isoflurane. Adult male Sprague-Dawley rats (n = 24; weight: 280–360 g) were selected and randomly divided into three groups: two experimental groups (sevoflurane group, n = 6; isoflurane group, n = 6) and a control group (urethane group, n = 12). The AIH protocol was identical in all studied groups and consisted in delivering five 3 min-long hypoxic episodes (fraction of inspired oxygen, FiO2 = 0.09), separated by 3 min recovery intervals at FiO2 = 0.5. Volatile anesthetics, isoflurane and sevoflurane, blunted the RSNA response to AIH in comparison to urethane anesthesia. Additionally, the PNA response to acute intermittent hypoxia was preserved, indicating that the respiratory system might be more robust than the sympathetic system response during exposure to acute intermittent hypoxia.

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Section: Discussioncontrasting

confidence: 46%

Section: Discussioncontrasting

confidence: 46%

The Effects of Volatile Anesthetics on Renal Sympathetic and Phrenic Nerve Activity during Acute Intermittent Hypoxia in Rats

Krnić,

Madirazza,

Pecotić

et al. 2024

Biomedicines

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“…The kidney is densely innervated by sympathetic nerves. Activation of these nerves increases renal vascular resistance and reduces renal blood flow by releasing norepinephrine and renin [170,171]. Moreover, activation of these nerves increases NHE3 and Na + ,K + -ATPase activity [172][173][174].…”

Section: Sympatholyticsmentioning

confidence: 99%

“…Acute kidney injury is frequently accompanied by activation of the sympathetic nerves. Inhibition of the sympathetic nervous system has been repeatedly demonstrated to alleviate AKI in various animal models [170,171]. However, the clinical benefit of this approach is inconsistent.…”

Section: Sympatholyticsmentioning

confidence: 99%

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Zhou¹

2023

Front. Biosci. (Landmark Ed)

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Maintaining a balance between the supply and demand of oxygen is vital for proper organ function. Most types of acute kidney injury (AKI) are characterized by hypoxia, a state where the supply of oxygen cannot match the demand for normal cellular activities. Hypoxia results from hypo perfusion and impaired microcirculation in the kidney. It inhibits mitochondrial oxidative phosphorylation, resulting in a decrease in production of adenosine triphosphate (ATP), which is essential to power tubular transport activities, especially reabsorption of Na + , and other vital cellular activities. To ameliorate AKI, the majority of studies have focused on increasing renal oxygen delivery by restoring renal blood flow and altering intra-renal hemodynamics. However, to date these approaches remain inadequate. In addition to augmenting oxygen supply, increasing renal blood flow also increases glomerular filtration rate, leading to increased solute deliver and workload for the renal tubules, causing an increase in oxygen consumption. The relationship between Na + reabsorption and oxygen expenditure in the kidney is linear. Experimental models have demonstrated that inhibition of Na + reabsorption can alleviate AKI. Since the proximal tubules reabsorb approximately 65% of filtered Na + , consuming the largest portion of oxygen, many studies focus on examining the effects of inhibiting Na + reabsorption in this segment. Potential therapeutics that have been examined include acetazolamide, dopamine and its analog, inhibitors of the renin-angiotensin II system, atrial natriuretic peptide, and empagliflozin. The effectiveness of inhibition of Na + reabsorption in the thick ascending limb of the Loop of Henle by furosemide has been also examined. While these approaches produced impressive results in animal models, their clinical benefits remain mixed. This review summarizes the progress in this area and argues that the combination of increasing oxygen supply with decreasing oxygen consumption or different approaches to reducing oxygen demand will be more efficacious.Keywords: mitochondria; oxygenation; hypoxia; Na + -H + exchanger 3; Na + -dependent glucose transporter 2; Na + reabsorption

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“…In particular, some anesthesia procedure or drugs might influence renal function. [6][7][8][9][10][11][12] Thus, an urgent clinical problem is to protect perioperative renal function and to promote early postoperative recovery. Quadratus lumborum block (QLB) is an abdominal truncal block that provides analgesia for abdominal surgery including laparoscopic gastrectomy, cesarean section, laparoscopic colorectal surgery, laparoscopic hepatectomy, and LRS.…”

Section: Introductionmentioning

confidence: 99%

Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study

Li,

Wang,

Sun

et al. 2023

DDDT

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The combination of different anesthesia techniques or adjuvant drugs can relieve the stress response to surgery, reduce adverse reactions and improve the clinical outcome. We investigated the effects of subcostal anterior quadratus lumborum block (SQLB) with and without dexmedetomidine (DEX) on postoperative rehabilitation for laparoscopic renal surgery (LRS). Methods: We included 90 patients in this single-center study. All were scheduled for elective laparoscopic radical or partial nephrectomy under general anesthesia (GA). We randomly and evenly assigned them to three groups: Group GA (GA alone), Group QG (SQLB with 30 mL of 0.25% ropivacaine and GA), and Group DQG (SQLB with 30 mL of 0.25% ropivacaine plus 1 μg/kg DEX and GA). The primary outcomes were serum creatinine (Cr) and blood urea nitrogen (BUN) levels; the secondary outcomes included the average numeric rating scale (NRS) scores at rest and during activity within 48 h postoperatively; perioperative opioid consumption; the time to first ambulation, exhaust, and fluid intake, and postoperative adverse reactions. Results:The serum Cr and BUN levels in Group DQG decreased significantly compared with Group GA (P < 0.05). The average NRS scores in Group DQG were significantly lower than other two groups (P < 0.05). Furthermore, the indexes reduced significantly in Group QG compared with Group GA (P < 0.05). Groups DQG and QG had lower consumption of opioid compared with Group GA (P < 0.05). The recovery indicators in Groups DQG and QG were higher quality than Group GA (P < 0.05). The incidences of adverse reactions in Group DQG was significantly lower than the other groups (P < 0.05). Conclusion: SQLB with and without DEX could attenuate postoperative pain, reduce opioids requirement and side effects, as well as facilitate postoperative early rehabilitation. More interesting, SQLB with DEX could confer kidney protection.

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Anesthesia and the renal sympathetic nervous system in perioperative AKI

Cited by 6 publications

References 100 publications

The Effects of Volatile Anesthetics on Renal Sympathetic and Phrenic Nerve Activity during Acute Intermittent Hypoxia in Rats

The Effects of Volatile Anesthetics on Renal Sympathetic and Phrenic Nerve Activity during Acute Intermittent Hypoxia in Rats

Reducing Oxygen Demand to Alleviate Acute Kidney Injury

Effects of Subcostal Anterior Quadratus Lumborum Block with and without Dexmedetomidine on Postoperative Rehabilitation in Patients Undergoing Laparoscopic Renal Surgery: A Prospective Double-Blinded Randomized Controlled Study

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