Welcome back to Niko’s Perioperative.

Because staying curious makes all the difference!

In this episode, we explore two groundbreaking publications from the esteemed journal “Anesthesiology” that have the potential to revolutionize our assessment of cardiovascular risk in non-cardiac surgical procedures.

We begin with Dr. Daniel Sessler’s compelling editorial, “Just Do It!”, where he advocates for the urgent implementation of preoperative troponin testing as a standard tool to predict and mitigate perioperative cardiovascular complications. Sessler’s insights set the stage for a transformative approach to perioperative care.

Then, we dive into the prospective study by Zhao and colleagues, which is the focus of Dr. Sessler’s editorial. This study evaluates the predictive power of NT-proBNP and high-sensitivity troponin T biomarkers. We discuss how combining these biomarkers with clinical indices like the Revised Cardiac Risk Index can significantly enhance our ability to identify patients at risk for major complications.

Join us for a conversation that bridges recent evidence with daily clinical practice, helping anesthesiologists make more informed decisions and improve patient safety.

Don’t miss this insightful episode packed with practical knowledge to elevate your perioperative care!

Stay curious!

References for this episode include:

1. ​1. Zhao, B.-C. et al. Preoperative N-terminal Pro–B-type Natriuretic Peptide and High-sensitivity Cardiac Troponin T and Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study. Anesthesiology 141, 475–488 (2024).
2. ​2. Sessler, D. I. Just Do It! Anesthesiology 141, 428–430 (2024).

Welcome back to Niko’s Perioperative.

Because staying curious makes all the difference!

In this episode, we take a dive into the evolving world of Acute Kidney Injury (AKI) in anesthesiology. We explore the monumental changes and advancements that have occurred since the game-changing 2012 KDIGO guidelines were released.

Throughout our conversation, we uncover the potential of cutting-edge biomarkers to revolutionize the early detection and management of AKI, offering us unprecedented insights into this critical condition. We navigate the ongoing controversies in fluid management—debating crystalloids; balanced solutions vs. normal saline, and restrictive vs. liberal fluid strategies—to uncover what the latest research says. We examine the complexities of blood pressure management during surgery, highlighting how individualized care is reshaping our approach to hemodynamic targets. We also debunk common myths surrounding AKI management and prevention. Looking ahead, we explore potential advancements in AKI care, including personalized medicine, the role of biomarkers in risk assessment, and the importance of understanding AKI trajectories.

Check all the references mentioned on the episode bellow ↓↓

Stay Curious!

References for this episode include:

1. Kellum, J. A., et al.(2012). Kidney disease: Improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney International Supplements, 2(1), 1–138.
2. Haase, M., Kellum, J. A., & Ronco, C. (2012). Subclinical AKI - An emerging syndrome with important consequences. In Nature Reviews Nephrology (Vol. 8, Issue 12, pp. 735–739).
3. Asfar, P., et al.(2014). High versus Low Blood-Pressure Target in Patients with Septic Shock (SEPSISPAM). The NEJM, 370(17), 1583–1593.
4. Weisbord, S. D., et al.(2018). Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine (PRESERVE Trial). The NEJM, 378(7), 603–614.

Balanced solutions vs. normal saline

1. Young, P., et al. (2015). Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: The SPLIT randomized clinical trial. JAMA , 314(16), 1701–1710.
2. Self, W. H., et al. (2018). Balanced Crystalloids versus Saline in Noncritically Ill Adults (SALT-ED). New England Journal of Medicine, 378(9), 819–828.
3. Semler, M. W., (2018). Balanced Crystalloids versus Saline in Critically Ill Adults. (SMART trial). The NEJM, 378(9), 829–839.
4. Zampieri, F. G., et al. (2021). Effect of Intravenous Fluid Treatment with a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial. JAMA, 326(9), 818–829.
5. Finfer, S., et al. (2022). Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. (PLUS Study) The NEJM, 386(9), 815–826.
6. Hammond, N. E., (2022). Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis. NEJM Evidence, 1(2).

Restrictive vs. liberal approach.

1. Hjortrup, P. B., The CLASSIC Trial Group, & The Scandinavian Critical Care Trials Group. (2016). Restricting volumes of resuscitation fluid in adults with septic shock after initial management: the CLASSIC randomised, parallel-group, multicentre feasibility trial. Intensive Care Medicine, 42(11), 1695–1705.
2. Meyhoff, T. S., et al. (2022). Restriction of Intravenous Fluid in ICU Patients with Septic Shock (CLASSIC main Trial). The NEJM, 386(26), 2459–2470.
3. Myles, P. S., et al.(2018). Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF). The NEJM, 378(24), 2263–2274.
4. National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network (2023). Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension (CLOVERS). The NEJM, 388(6), 499–510.

Welcome back!

Because staying curious is what makes all the difference.

In this episode, we’re excited to explore the fascinating world of Acute Normovolemic Hemodilution (ANH), as a blood conservation strategy. We will delve into its intricacies and explore its possibilities!

We explore how ANH not only reduces the need for allogeneic blood transfusions but also improves patient outcomes and offers cost-effective solutions in perioperative care, especially in complex surgeries with anticipated significant blood loss.

Join us in this engaging conversation as we share practical insights and reflections on, the fundamentals of ANH and its procedural steps, patient selection criteria, the effectiveness and safety of ANH.

Don’t miss this episode filled with insights to enhance our patients’ perioperative care.

Stay Curious!

References for this episode include:

1. AABB. Standards for Perioperative Autologous Blood Collection and Administration, 10th ed, 2023.

2. Shander A, et al. Standards and Best Practice for Acute Normovolemic Hemodilution: Evidence-based Consensus Recommendations. J Cardiothorac Vasc Anesth 2020; 34:1755.

3. Zhou X, et al. Preoperative Acute Normovolemic Hemodilution for Minimizing Allogeneic Blood Transfusion: A Meta-Analysis. Anesth Analg 2015; 121:1443.

4. Segal JB, et al. Preoperative acute normovolemic hemodilution: a meta-analysis. Transfusion 2004; 44:632.

5. Kinoshita H, et al. Impact of acute normovolemic hemodilution on allogeneic blood transfusion during open abdominal cancer surgery: A propensity matched retrospective study. J Clin Anesth 2020; 64:109822.

6. Ni Y, et al. Acute normovolemic hemodilution for major cancer surgeries during the COVID-19 pandemic: A beacon of hope. J Clin Anesth 2020; 65:109871.