Naslov
Hypothermia in urology

Autori
Peršec Zoran

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, stručni

Izvornik
18. simpozij intenzivne medicine s međunarodnim sudjelovanjem Zbornik radova/Abstract Book / - Zagreb : Hrvatsko društvo za intenzivnu medicinu HLZ, 2012

Skup
18. simpozij intenzivne medicine s međunarodnim sudjelovanjem

Mjesto i datum
Rovinj, Hrvatska, 18.06.2012. - 21.06.2012

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Nije recenziran

Ključne riječi
Local hypothermia; kidney operation

Sažetak
Local hypothermia is most effective and most used method to preserve kidneys from ischemic damage during various surgical procedures on kidney. Decreasing the temperature leads to reduction of renal energy-dependent metabolic activity of renal cortical cells, resulting in lowering of oxygen consumption and ATP .Experimental work of Ward 1975th, considered the optimum temperature of the local renal tissue around 15 °C. In clinical practice the optimum temperature for local hypothermia is between 20-25 °C . Techniques for achieving renal hypothermia for operations are: - using ice slush - perfusion with cold solution introduced by retrograde ureteral catheter - perfusion of renal blood vessels with a cold solution Kidney surgery with local hypothermia: - oncologycal surgery (partial nephrectomy) - nephrolithiasis (nephrolithotomy) - transplantation surgery (kidney explantation) Clinical Hospital Dubrava perform all these operations. Annually about cca 5-10 local hypothermia in the treatment - partial nephrectomy or renal lithiasis surgery in hypothermia and 1o-18 donor kidney explantation.Today it is considered that there are three interrelated main mechanisms by which ischemic damage occurs to the kidneys: vascular, caused by sustained vasoconstriction and abnormal responses of the compensatory mechanisms of endothelial cells of renal tubules ; obstructive, where tubular epithelial cells and their brushes cell membranes impede the flow of glomerular filtrate through the tubules of denuded lumen in the capillaries and circulation (back-leak) causing a reduction in "effective" GFR, and mechanism is related to the reperfusion injury that occurs after the return of blood flow (revascularization). In conclusions, the maximum permitted length of warm ischemia (WI) before the occurrence of irreversible kidney damage could be the subject to academic debate, regardless of the surgical procedure performed on the kidney. Clinical and practical variations in preoperative renal status of patients treated, applied surgical technique, patient age, presence of collateral vasculature, affecting the possible occurrence of damage and kidney function. There is no method for the preoperative or intraoperative monitoring of the possible occurrence of renal insufficiency. it is essential to shorten warm ischemia time as possible, and avoids unnecessary manipulation or manipulation of the renal arteries - surgeon skills. Preoperative and intraoperative hydration, prevention of intraoperative hypotension, administration of mannitol are required to preserve adequate kidney perfusion before and after surgery – anesthesiologist skills.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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