Incidence and Risk Factors Analysis of Acute Kidney Injury (AKI) After Intentional Hypotensive Anesthesia in Orthognathic Surgery Patients Following Enhanced Recovery After Surgery (ERAS) Guidelines
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 50
- 试验地点
- 1
- 主要终点
- consumption of inhaled and intravenous anesthetics
研究概览
简要总结
This project investigates intentionally hypotensive management such as NTG (nitroglycerin) or NTG+Trandate during general anesthesia in patients undergoing orthognathic surgery. Throughout the entire surgical procedure, blood biochemical and urine monitoring will be conducted. Serum creatinine (Cr) levels, urine analysis, and perioperative monitoring will be utilized as indicators for assessing renal function during the surgery. The objective is to assess its potential renal injury and identify early risk factors for acute kidney injury (AKI). Timely recognition of these factors will allow for the implementation of appropriate intervention strategies, aiding in the prevention of postoperative acute kidney injury. This approach contributes to achieving the goals of Enhanced Recovery After Surgery (ERAS) for surgical patients, promoting faster postoperative recovery.
详细描述
Orthognathic surgery is currently a common procedure in oral and maxillofacial surgery. The facial region is composed of a complex and dense vascular network, requiring precise, accurate, and delicate surgical techniques on both hard and soft tissues. During intraoral procedures, the surgical field may be limited, making the management of surgical bleeding challenging. Controlled hypotension or hypotensive anesthesia is often employed during major maxillofacial surgeries to optimize conditions. Lowering blood pressure is advantageous as it helps reduce overall blood loss and improves the surgeon's visibility. Therefore, maintaining stable blood pressure within the ideal range during the surgical process is a critical anesthesia objective.
This research emphasizes the prevention of acute kidney injury (AKI) in patients undergoing orthognathic surgery with intentional hypotension during general anesthesia. The goal is to detect the potential renal damage at an early stages, before a significant decline in kidney function occurs, thereby reducing the likelihood of acute kidney injury.
研究设计
- 研究类型
- Observational
- 观察模型
- Case Control
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •America society anesthesiologist classification class I to II patients undergoing oro-maxillo-facial surgery
- •unlimited mouth opening
排除标准
- •patients with arthritis with limited mouth opening
- •persistent liver dysfunction
- •chronic renal insufficiency
- •body mass index ≧35 kg/m
- •past history of malignant hyperthermia or personal or family history
- •diabetes with insulin treatment
- •essential hypertension without controlled
结局指标
主要结局
consumption of inhaled and intravenous anesthetics
时间窗: intraoperative 2-6 hours
to maintain adequate depth of anesthesia during intentional hypotension, consumptions of inhaled and intravenous anesthetics are calculated
urine biomarkers assessment, urine output, and blood Creatinine from participants undergoing Orthognathic surgery.
时间窗: intraoperative and postoperative stages, assessed up to 24 hours
Record blood and urine biomarkers, and urine output after operation
permitted hypotension during surgery
时间窗: intraoperative 2-6 hours
assess intraoperative blood loss and the dosage of hypotensive medications to decrease intra-operative bleeding as patient undergoing oromaxillofacial surgery, intentional hypotension is allowed. however, adequate depth of anesthesia, proper cardiac output, respiratory parameters, temperatures should be monitored
次要结局
- safely discharged from post-anesthesia care unit (postoperative recovery room)(2 hours)
- side effects and adverse events(intraoperative and postoperative stages, assessed up to 48 hours)
- time to successfully extubate the nasotracheal tube after anesthesia(from the end of surgery to the post-anesthesia care, assessed up to one hour)