SummaryIntroductionAcute kidney injury develops frequently after nephrectomy, causing increased hospital duration of stay and mortality. Both propofol and volatile anaesthetic agents are thought to have renoprotective effects. We investigated whether the type of maintenance anaesthetic (propofol or desflurane) affected the incidence of acute kidney injury after nephrectomy.MethodsThis single‐centre, randomised controlled trial enrolled adult patients with renal cell carcinoma undergoing nephrectomy. In patients allocated to the propofol group, anaesthesia was induced and maintained using a target‐controlled infusion of propofol. In patients allocated to the desflurane group, anaesthesia was induced with a bolus of thiopental and maintained with desflurane. Both groups received a target‐controlled infusion of remifentanil during surgery. The primary outcome was the incidence of acute kidney injury within 7 postoperative days based on the serum creatinine component of the Kidney Disease: Improving Global Outcomes criteria.ResultsWe analysed 317 patients (median (IQR [range]) age 62 (52–70 [26–85] y); 221 (70%) men). Postoperative AKI developed in 79 (25%) patients: 43 (27%) in the propofol group and 36 (23%) in the desflurane group (absolute risk difference (95%CI) 4.6 (‐4.9–14.0%), p = 0.347). The severity of kidney injury was stage 1 in 76 patients, stage 2 in two patients and stage 3 in one patient.DiscussionThe type of anaesthetic maintenance drug (propofol vs. desflurane) did not affect the incidence of acute kidney injury after nephrectomy. Future research might be better directed towards investigating other potentially modifiable risk factors for postoperative acute kidney injury in this patient population.

中文翻译：

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麻醉类型对肾切除术后急性肾损伤的影响：一项随机对照试验


摘要引言肾切除术后经常发生急性肾损伤，导致住院时间和死亡率增加。异丙酚和挥发性麻醉剂都被认为具有肾脏保护作用。我们调查了维持麻醉剂的类型 （丙泊酚或地氟醚） 是否影响肾切除术后急性肾损伤的发生率。方法这项单中心、随机对照试验招募了接受肾切除术的成年肾细胞癌患者。在分配到异丙酚组的患者中，使用目标对照输注异丙酚诱导并维持麻醉。在分配到地氟烷组的患者中，用硫喷钠推注诱导麻醉，并用地氟烷维持麻醉。两组在手术期间均接受目标对照输注瑞芬太尼。主要结局是根据肾脏疾病：改善总体结局标准的血清肌酐成分，术后 7 天内急性肾损伤的发生率。结果我们分析了 317 名患者 （中位 （IQR [范围]） 年龄 62 岁 （52-70 [26-85] 岁;221 名 （70%） 男性）。79 例 （25%） 患者术后发生 AKI：丙泊酚组 43 例 （27%），地氟烷组 36 例 （23%） （绝对风险差 （95%CI） 4.6 （-4.9-14.0%），p = 0.347）。76 例患者肾损伤严重程度为 1 期，2 例患者为 2 期，1 例患者为 3 期。讨论麻醉维持药物的类型 （异丙酚与地氟烷） 不影响肾切除术后急性肾损伤的发生率。未来的研究可能更好地针对调查该患者群体术后急性肾损伤的其他潜在可改变的危险因素。