Abstract
Introduction: Among the perioperative complications encountered in patients with renal failure, there is a high risk of events such as heart failure and increased susceptibility to infection. Herein, we report the results of our investigation of perioperative management in patients with chronic renal failure who underwent a pulmonary resection. Methods: The subjects were 21 hemodialysis patients with renal failure who underwent pulmonary resection for lung cancer. We retrospectively investigated their clinical characteristics and perioperative management. The patients were classified into two groups; those with and without symptoms of postoperative acute heart failure. Intergroup comparisons of preoperative examinations and management were performed. Results: The most common preoperative comorbidity was cardiac complications, which occurred at a high incidence of 38%. There were no serious perioperative complications. In contrast, postoperative complications associated with renal failure were numerous, including acute heart failure in 3 (14%) and hyperkalemia in 2 (9.5%). We concluded that preoperative respiratory function, intraoperative fluid infusion volume, and preoperative cardiac comorbidities are potential risk factors for postoperative heart failure in such patients. Conclusion: Although there were no cases with perioperative mortality, postoperative complications were encountered, including heart failure and hyperkalemia, suggesting that more stringent cardiovascular and respiratory management techniques are necessary.
Highlights
Among the perioperative complications encountered in patients with renal failure, there is a high risk of events such as heart failure and increased susceptibility to infection
We investigated perioperative management methods used and the incidence of complications in hemodialysis patients with chronic renal failure who underwent a pulmonary resection procedure at our hospital
Postoperative complications were defined as follows: 1) heart failure diagnosed via echocardiography by a cardiovascular specialist and characterized by findings of pulmonary congestion on chest radiography, which required catecholamine treatment for decreased blood pressure within 3 days after surgery; 2) pneumonia shown by a white cell count of 12 000 mm-3 or greater, a fever of 38 degrees or greater and findings of decreased permeability in both lung fields by chest radiography, with diagnosis made by a radiologist who specializes in respiratory disease within 1 week after surgery; and 3) the presence of hyperkalemia, as indicated by a potassium level of 6.5 mEq L-1 or greater in blood tests on the day of surgery
Summary
Among the perioperative complications encountered in patients with renal failure, there is a high risk of events such as heart failure and increased susceptibility to infection. We report the results of our investigation of perioperative management in patients with chronic renal failure who underwent a pulmonary resection. There is an elevated risk of perioperative complications in patients with renal failure, such as heart failure and increased susceptibility to infection. We investigated perioperative management methods used and the incidence of complications in hemodialysis patients with chronic renal failure who underwent a pulmonary resection procedure at our hospital. We point out potential problems encountered when performing perioperative management in regard to safe pulmonary resection procedures in the increasing number of hemodialysis patients and discuss various solutions
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