SGB Reduces the Incidence and Severity of CSA-AKI

Yangzhou University396 enrolled

Overview

The incidence of acute kidney injury after cardiopulmonary bypass cardiac surgery is high, which increases postoperative mortality and is not conducive to the prognosis of patients. Stellate ganglion blocks increase renal blood flow, reduce inflammation and stress, and protect the heart muscle. In this study, stellate ganglion block was used to promote rapid recovery of kidney function after cardiopulmonary bypass cardiac surgery.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

396

Conditions

Stellate Ganglion Block

Interventions

Stellate ganglion blockDRUG

After the induction of general anesthesia and before the start of the surgery,ultrasound-guided stellate ganglion block is performed, injecting 5 ml of 0.375% ropivacaine.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Patients of any gender were eligible provided they were between the ages of 18 and 80 years; 2. American Society of Anesthesiologists (ASA) class of Ⅲ or IV. Exclusion Criteria: 1. emergency cardiac surgery； 2. major vascular surgery； 3. non-sinus rhythm, reoperation； 4. contraindications for TEE or SGB； 5. abnormal preoperative renal function； 6. severe preoperative heart failure with left ventricular ejection fraction \< 30%, multi-organ dysfunction； 7. and severe infection requiring continuous antibiotic treatment; 8. enrolled in another clinical trial. Elimination criteria: 1. incomplete follow-up data; 2. withdrawal during the procedure; 3. SGB failure or complications; 4. insufficient ultrasonographic imaging of the left renal artery on TEE; 5. repeated CPB during surgery; 6. need for cardiac assist devices (extracorporeal membrane oxygenation, intra-aortic balloon pump, or ventricular assist devices) after CPB completion.

Locations (1)

the Affiliated Hospital of Yangzhou University, Yangzhou University

Yangzhou, Jiangsu, China

Outcomes

Primary Outcomes

The incidence and severity of CSA-AKI

Postoperative serum creatinine was detected once a day from the patient's arrival in the ICU until postoperative day 7. The severity of CSA-AKI was graded by the change in the plasma creatinine levels, according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria

Time frame: From the end of surgey to postoperative day 7

Secondary Outcomes

Changes of intraoperative left RBF parameters

The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean blood flow velocity (V-mean), the diameter of the left renal artery (RAD)and velocity time integral (VTI) of the left renal artery were measured

Time frame: 5 minutes after general anesthesia induction,15 minutes after the SGB procedure in Group S and 20 minutes after the completion of the first TEE examination in Group C, and 30 minutes after the end of CPB

Changes of perioperative BNP, CK-MB, IL-6, CRP, IL-18, and norepinephrine levels

Venous blood samples were collected to test BNP (Brain natriuretic peptide), CK-MB (Creatine kinase isoenzymes), kidney injury molecule-1 (KIM-1), interleukin (IL)-6, C-reactive protein (CRP), IL-18, and norepinephrine levels.

Time frame: preoperatively, Immediately after the surgery,the first day after surgery,the second day after surgery, and the seventh day after surgery

Comparison of recovery indicators between the 2 groups

The duration of mechanical ventilation in the ICU, length of ICU stay, length of postoperative hospitalization in the ward, and in-hospital mortality were recorded

Time frame: From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 100 months

Hemodynamic changes during surgery.

The MAP from the radial artery,HR,CVP, and cardiac output.

Data from ClinicalTrials.gov

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