Diabetes kidney disease is a leading cause for end stage renal disease in the western world.
To date no treatment that can reverse renal damage exists.
Chronic hypoxia is one of the major key insults affecting the diabetic kidney, and many of
the new treatments under study focus on it’s consequences, but no treatment can improve the
hypoxia as both increased renal perfusion and decreased renal perfusion may be associated
with it’s worsening. Hyperbaric oxygen therapy (HBOT) can improve renal hypoxia by increasing
partial pressure of dissolved (non-hemoglobin-bound) oxygen without affecting it’s demand.
HBOT also recruits tissue and peripheral progenitors and supplies the optimal environment
crucial for their proliferation and for tissue repair. Hyperbaric oxygen treatment was known
for years as an effective treatment for diabetic ulcers. Recent trials have shown great
impact on brain lesions (in diabetic and non-diabetic patients) it is now the time to
evaluate the effect of HBOT on the diabetic kidney.
Geriatric patients (age ≥ 65 years) undergo surgery for hip fractures that develops due to
osteoporosis and falls. Dialysis-dependent chronic kidney disease is associated with an
increased risk of cardiovascular comorbidity. Elective or urgent surgical operations may be
required for geriatric patients with end stage renal disease. These patients have severe
comorbidities, fluid, electrolyte disturbances and drug metabolism abnormalities during the
perioperative period. For this reasons a careful anesthesia plan should be planned and
performed. Spinal anesthesia can be used for hip fracture surgery at geriatric patients with
chronic renal failure. Anterograde femoral intramedullary nailing can be performed in supine
position with a fracture table. Intraoperative sedation might be necessary for patients under
regional anesthesia on traction table. Dexmedetomidine is an alpha 2 receptor agonist that is
being used as an agent for its sedative and adjuvant analgesic effects.
The aim of this study is to evaluate the effects of dexmedetomidine premedication on
geriatric patients with end stage renal disease, who will be undergoing a surgical operation
for hip fracture under spinal anesthesia with hyperbaric bupivacaine and BIS (Bispectral
Index) guided sedation with intraoperative propofol infusion.
