Awake Renal Transplantation; A Realistic Alternative to General Anesthesia

Abstract

A 63-year-old man with profound phobia of general anesthesia recently underwent successful renal transplantation in our unit under combined spinal-epidural anesthesia (CSEA). We believe that although this is not a novel technique, it is a realistic option for renal transplantation in patients in whom general anesthesia is not feasible. The use of CSEA for surgery below the umbilicus and its postoperative pain management has increased in popularity in recent years. Its use in renal transplantation is not widely reported; however, available articles suggest that it is a safe and useful alternative to general anesthesia, with no significant difference in anesthesia or surgical time, surgical conditions, hemodynamic stability, or early postoperative renal function. The procedure was performed with no alteration to the surgical technique usually adopted by the surgeon. The patient had a largely uneventful postoperative recovery, with good pain control and no significant complications. He has achieved good stable renal function, with a serum creatinine concentration of 105 μmol/L at 6 months (preoperative serum creatinine concentration, 832 μmol/L). We believe this case demonstrates that CSEA is a practical option for renal transplantation in the United Kingdom, and would recommend CSEA as a useful alternative to general anesthesia in patients with this type of phobia. Careful preoperative planning, patient selection, and consideration of a contingency plan meant that surgically the procedure proceeded as standard, with good results. Because of the success of this case, a second patient with phobia of general anesthesia has recently been placed on the regional transplantation waiting list.