title: The effect of anaesthetic management on neutrophil gelatinase associated lipocalin (NGAL) levels after robotic surgical oncology.
abstract: OBJECTIVE
  The main objective of this study was to compare the effect of two anaesthetic techniques (general vs combined) on plasma levels of NGAL (Neutrophil Gelatinase Associated Lipocalin) after robotic urogenital oncosurgery. The secondary objective was to correlate NGAL levels with the incidence of acute kidney injury (AKI).
  
  
  METHODS
  This was a longitudinal prospective study. Forty patients were included and randomized in 2 groups: group C (N=16 cases; combined general-epidural anesthesia) and group G (N=24 cases; control group with general anesthesia). Demographic data, Charlson Comorbidity Index, Apache II, SOFA and ASA scores were similar in both groups. Serum creatinine was determined preoperatively and every 24 hrs for 4 postoperative days to identify AKI according to RIFLE and AKIN criteria. Serum NGAL was determined at 6 and 12 hrs after induction of anesthesia.
  
  
  RESULTS
  Serum creatinine increased at 24 hrs postoperatively in both groups as compared to baseline, but significant changes were registered only in the G group (p(control) = 0.004). Serum NGAL increased significantly in both groups as compared with baseline levels (pcase=0.0034 vs p(control)=0.0001). The incidence of AKI was 12.50% (95% CI 0.4-34) in the C group and 37.50% (95% CI 17-58) in the G group (p=0.0909), respectively.
  
  
  CONCLUSIONS
  Impaired renal function and AKI occurred in robot-assisted laparoscopic urogenital oncosurgery under both general and combined anaesthesia. The incidence of AKI was lower in patients undergoing combined anesthesia compared to general anaesthesia after robotic urogenital oncosurgery but the difference did not reach statistical significance. However, plasma levels of NGAL were significantly increased at 6 and 12 hrs in the general anaesthesia group as compared with combined anaesthesia. NGAL may be a better marker in detecting postoperative acute kidney injury. Further studies are needed.
authors.affiliation: Department of Anesthesiology and Intensive Care Unit, Clinical Emergency County Hospital, Cluj-Napoca, Romania.
authors.forename: Mihaly
authors.initials: M
authors.lastname: Orsolya
authors.forename: Mihaly
authors.initials: M
authors.lastname: Attila-Zoltan
authors.forename: Vitalie
authors.initials: V
authors.lastname: Gherman
authors.forename: Florin
authors.initials: F
authors.lastname: Zaharie
authors.forename: Sorana
authors.initials: S
authors.lastname: Bolboaca
authors.forename: Cipriana
authors.initials: C
authors.lastname: Chira
authors.forename: Constantin
authors.initials: C
authors.lastname: Bodolea
authors.forename: Ciprian
authors.initials: C
authors.lastname: Tomuleasa
authors.forename: Alexandru
authors.initials: A
authors.lastname: Irimie
authors.forename: Ioan
authors.initials: I
authors.lastname: Coman
authors.forename: Daniela
authors.initials: D
authors.lastname: Ionescu
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D000209:Acute-Phase Proteins; D000368:Aged; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood*; D012371:Robotics; D012383:Romania / Q000453:epidemiology; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014565:Urogenital Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D003404:Creatinine