Perioperative acetaminophen is associated with reduced acute kidney injury after cardiac surgery

Young, Andrew M.; Strobel, Raymond J.; Rotar, Evan P.; Kleiman, Amanda M.; McNeil, John S.; Teman, Nicholas R.; Hawkins, Robert B.; Raphael, Jacob; Mehaffey, J. Hunter

doi:10.1016/j.jtcvs.2022.09.005

Cited by 4 publications

(4 citation statements)

References 38 publications

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“… 234 , 235 Animal studies and observational data suggest a potential link between acetaminophen use and reduced AKI risk in cardiac surgery patients. 234 , 236 , 237 Further clinical trials are needed to confirm its efficacy.…”

Section: Novel Concepts For Prevention and Treatment Of Csa-akimentioning

confidence: 99%

Cardiac Surgery–Associated Acute Kidney Injury

Scurt,

Bose,

Mertens

et al. 2024

Kidney360

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Acute kidney injury (AKI) is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (CSA-AKI) based on changes in serum creatinine and/or urine output. There are various pre-, intra-, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio (TIMP2/IGFBP7), other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention and treatment management.

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Section: Novel Concepts For Prevention and Treatment Of Csa-akimentioning

confidence: 99%

Cardiac Surgery–Associated Acute Kidney Injury

Scurt,

Bose,

Mertens

et al. 2024

Kidney360

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show abstract

“…142 Several observational retrospective studies have reported that exposure to acetaminophen was associated with decreased incidence of cardiac surgery-associated AKI in both adults and children undergoing cardiac surgery with cardiopulmonary bypass. 143,144 Furthermore, Janz et al 145 reported a phase IIa randomized placebo-controlled trial of acetaminophen in patients with severe sepsis and elevated circulating cell-free hemoglobin. Patients who received acetaminophen had lower levels of markers of lipid peroxidation as well as lower serum creatinine.…”

Section: Acetaminophenmentioning

confidence: 99%

Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management

Cheruku,

Raphael,

Neyra

et al. 2023

Anesthesiology

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Acute kidney injury (AKI) is a common complication in cardiac surgery patients, with a reported incidence of 20 to 30%. The development of AKI is associated with worse short- and long-term mortality, and longer hospital length of stay. The pathogenesis of cardiac surgery–associated AKI is poorly understood but likely involves an interplay between preoperative comorbidities and perioperative stressors. AKI is commonly diagnosed by using increases in serum creatinine or decreased urine output and staged using a standardized definition such as the Kidney Disease Improving Global Outcomes classification. Novel biomarkers under investigation may provide earlier detection and better prediction of AKI, enabling mitigating therapies early in the perioperative period. Recent clinical trials of cardiac surgery patients have demonstrated the benefit of goal-directed oxygen delivery, avoidance of hyperthermic perfusion and specific fluid and medication strategies. This review article highlights both advances and limitations regarding the prevention, prediction, and treatment of cardiac surgery–associated AKI.

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“…However, it does note that as neuraxial analgesia weans, the oral formulation becomes more effective [ 55 ]. In patients undergoing cardiac surgery, one study reported a benefit of IV acetaminophen administration in the form of reduced incidence of AKI [ 56 ]. Generally, ERAS application of acetaminophen is widely applied to cases such as thoracic/lung surgery, open laparotomy, total hip and knee arthroplasties, cesarean sections, and even in liver transplantation [ 57 ].…”

Section: Non-opioid Agents In the Perioperative Settingmentioning

confidence: 99%

ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting

Zwolinski

Patel

Vadivelu

et al. 2023

Curr Pain Headache Rep

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Even prior to the COVID-19 pandemic, rates of ambulatory surgeries and ambulatory patients presenting with substance use disorder were increasing, and the end of lockdown has further catalyzed the increasing rates of ambulatory patients presenting for surgery with substance use disorder (SUD). Certain subspecialty groups of ambulatory procedures have already established protocols to optimize early recovery after surgery (ERAS), and these groups have subsequently enjoyed improved efficiency and reduced adverse outcomes as a result. In this present investigation, we review the literature as it relates to substance use disorder patients, with a particular focus on pharmacokinetic and pharmacodynamic profiles, and their resulting impact on the acute- or chronic user ambulatory patient. The systematic literature review findings are organized and summarized. We conclude by identifying areas of opportunity for further study, specifically with the aim of developing a dedicated ERAS protocol for substance use disorder patients in the ambulatory surgery setting. Key Summary Points - Healthcare in the USA has seen an increase in rates of both substance use disorder patients and separately in ambulatory surgery cases. - Specific perioperative protocols to optimize outcomes for patients who suffer from substance use disorder have been described in recent years. - Agents of interest like opioids, cannabis, and amphetamines are the top three most abused substances in North America. - A protocol and recommend further work should be done to integrate with concrete clinical data, in which strategies should be employed to confer benefits to patient outcomes and hospital quality metrics like those enjoyed by ERAS protocol in other settings.

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Perioperative acetaminophen is associated with reduced acute kidney injury after cardiac surgery

Cited by 4 publications

References 38 publications

Cardiac Surgery–Associated Acute Kidney Injury

Cardiac Surgery–Associated Acute Kidney Injury

Acute Kidney Injury after Cardiac Surgery: Prediction, Prevention, and Management

ERAS Protocol Options for Perioperative Pain Management of Substance Use Disorder in the Ambulatory Surgical Setting

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