Anesthesia For Renal Transplantation Research Articles

Establishing targets for goal-directed anesthesia in renal transplantation: A cohort analysis of high-saliency surgical time courses

Delayed graft function (DGF) increases morbidity and mortality in kidney transplant recipients. Operative parameters, including hemodynamic manipulation through vasopressors and fluids, can impact perfusion to the newly transplanted kidney and influence DGF incidence. We analyzed intraoperative time-series data in 5-minute intervals from kidney transplant recipient operations (N = 545) in conjunction with pretransplant characteristics and postsurgical outcomes, including DGF incidence, 60-day creatinine, and graft survival. Of the operations, 127 DGF events were captured in our cohort from a single academic transplant center (57/278 donations after brainstem death [DBDs], 65/150 donations after circulatory/cardiac death [DCDs], 5/117 live donations). In multiple regression, postanastomosis hypotension defined as mean arterial pressure (MAP) <75 mmHg was a risk factor for DGF independent of conventional predictors of DGF in DCD and DBD kidneys. DCD recipients with DGF had lower average postanastomosis MAP (DGF: 80.1 ± 8.1 mmHg vs no DGF: 76.4 ± 6.7 mmHg, P = .004). Interaction analysis demonstrated above-average doses of vasopressors and crystalloids were associated with improved outcomes when used at MAPs ≤75 mmHg, but they were associated with increased DGF at MAPs >75 mmHg, suggesting that the incidence of DGF can be highly influenced by intraoperative hemodynamic controls. This analysis of surgical time courses has identified potential new strategies for goal-directed anesthesia in renal transplantation.

Considerations regarding anesthesia for renal transplantation.

Renal transplantation is a complex surgical procedure requiring meticulous anesthetic planning to ensure patient safety and optimal graft function. In this comprehensive review, we examined various aspects of anesthesia management during renal transplantation, including preoperative, intraoperative, and postoperative care. Preoperative optimization involves the identification and management of risks to mitigate perioperative complications. Treatment with erythropoiesis-stimulating agents is recommended to correct anemia in transplant recipients with hemoglobin levels below 9-10 g/dl. Intraoperative management focuses on hemodynamic monitoring, maintenance of intravascular volume, and careful selection of anesthetic techniques. Neuromuscular monitoring and the appropriate use of neuromuscular blocking and reversal agents are considered essential. Further, hemodynamic goals include maintaining the mean arterial pressure within the range of 80-110 mmHg. In addition, attention should be paid to perioperative glycemic control, temperature management, and diuretic use. In postoperative management, multimodal analgesia and the prevention of postoperative delirium contribute to optimal recovery. The implementation of enhanced recovery after surgery principles can further improve outcomes. Collaborative efforts among surgical teams, anesthesiologists, and healthcare professionals are crucial for achieving successful renal transplantation outcomes.

Anesthetic Management of Patients Undergoing Renal Transplantation: A Review of A Two-year Experience

Objectives: This study reviewed the anesthetic management procedures used for renal transplantation patients at a university hospital in Turkey over a two-year period. Areas of interest included preoperative status, fluid management, perioperative complications, and postoperative analgesia. Methods: A retrospective review of hospital records and information collected from all patients undergoing renal transplantation, performed at Ondokuz Mayıs University Hospital from 2018 to 2020, was conducted. Results: A total of 90 renal transplants were performed during the study time period. Of the patients undergoing renal transplantation, 44.4% were female and 55.6% were male. 52 patients were recipients of cadaveric transplants and 38 patients received kidneys from living, related donors. The duration of surgery and cold ischemic time were longer in the recipients of the cadaveric transplants (p &lt; 0.05). Delayed graft function was statistically significantly higher in the kidney transplants obtained from the cadaveric donors than the living donors (p &lt; 0.05). Conclusions: This study showed that anesthesia for renal transplantation is a safe and effective method if a selected range of drugs and techniques is used. Applying a well-planned standard anesthesia protocol and updating it periodically in line with the current literature will contribute to improving the quality of the outcomes renal transplantation surgery.

Application of staged goal-directed fluid therapy in anesthesia for renal transplantation

Objective To observe the application of staged goal-directed fluid therapy (GDFT) in anesthesia for renal transplantation. Methods A total of thirty patients scheduled for allogeneic renal transplantation were randomly divided into two groups, groups A and B (n=15). Group A was given staged goal-directed fluid therapy [stroke volume variation (SVV) ≤13 was set in accordance with the surgical progress before refusion in the new kidney and ≤10 after refusion, which is the basis of fluid management]. Meanwhile, group B was given goal-directed fluid therapy(where SVV≤13 was set). Then, the mean artery pressure (MAP), heart rate and stroke volume (SV) were recorded before the surgery after anesthesia, before refusion in the new kidney and 15 min after refusion. Furthermore, the content of blood lactic acid before and after surgery, the blood creatinine (Cr) content and urine volume before the surgery and 1, 2 d and 3 d after surgery were also recorded. Results There was no differences in MAP, heart rate and SV between the two groups before surgery (P>0.05). Group A presented remarkably increases in MAP and SV before refusion and 15 min after refusion, compared with group B (P 0.05). Conclusions Application of staged goal-directed fluid therapy in anesthesia for renal transplantation is favorable for recovery of renal functions after renal transplantation, if adequate blood perfusion can be ensured for the kidney. Key words: Staged goal-directed fluid therapy; Stroke volume variation; Renal transplant

Anesthesia for renal transplantation in patients with dilated cardiomyopathy: a retrospective study of 31 cases

Background and objectivesDilated cardiomyopathy is a state of progressive enlargement of cardiac chambers mainly left ventricle which leads to decreased cardiac output and ultimately cardiac failure. Although it has multifactorial etiology, it is quite common in patients with end stage renal disease who require renal transplant surgery for their cure. Both conditions go side by side and anesthetic management of such cases poses real challenge to anesthesiologist. Strict monitoring and control of cardiac physiology is of utmost importance besides meticulous fluid management, thus preserving renal blood flow on one hand and preventing cardiac failure on other hand. This is the basis of achieving good outcome of the renal transplant surgery. MethodsThis is a retrospective observational study done by analysing electronic database of 31 patients with dilated cardiomyopathy who underwent renal transplant surgery. Data was studied in terms of demographics, duration of renal disease, comorbidities mainly hypertension, cardiac echo graphic findings including ejection fraction, medications and post-operative outcome. ResultsMost common perioperative complication in this patient population was hypotension (51.61%) followed by pulmonary complications postoperative mechanical ventilation (12.9%) and pulmonary edema (6.45%). High incidence of hypotension may be a causative factor to increased rate of delayed graft functioning (12.9%) and acute tubular necrosis (2.23%) in these patients. ConclusionStrict monitoring and control of hemodynamic parameters as well as meticulous fluid therapy is the cornerstone in improving outcome in patients with dilated cardiomyopathy undergoing renal transplant surgery.

Anesthesia and Kidney Transplantation

IntroductionChronic kidney disease (CKD) has diverse causes and the outcomes can change with renal transplantation, which has the potential to increase quality of life and improve survival. Because transplant recipients usually have comorbid conditions, presurgical assessment, optimization of health status, monitoring, and intraoperative anesthetic management are essential. ObjectiveThe objective of this study was to evaluate available medical literature concerning presurgical anesthetic assessment and intraoperative and postoperative anesthetic management of patients undergoing renal transplantation. Review CriteriaA bibliographic search was made in MEDLINE, OVID, and LILIACS without language or design limits. Available evidence from February 1991 to February 2011 was taken. Articles about anesthesia in renal transplantation were included. Information quality was assessed according to design type with “Critical Appraisal Skills Program” (CASP-UK) tools. Epidemiological data in Colombia were obtained from the Social Protection Ministry and FOSYGA (Solidarity and Guarantee Fund) web pages. ResultsRegarding prognosis, CKD mortality increases with dialysis and with its duration, whereas transplantation reduces it and enhances survival. Recipient mortality, functionality, and graft lifespan are influenced by donor type (immediate diuresis with living donors, P < .05), hydration (60–90 mL/kg), early diuresis (13% mortality rate at 1 year if delayed and reduction of graft lifetime 20%–40%). When comparing diuresis, clearance creatinine, kidney perfusion, and function, there were no significant differences between general and regional anesthesia. Nevertheless, postoperative analgesia was better with epidural anesthesia. ConclusionExamination of the patient and optimization of the overall health status contributes to graft optimal function and patient survival. Regional anesthesia has better control over postoperative pain, but it has no effect on the prognosis, The intraoperative maintenance of appropriate hydration enhances flux and renal perfusion, which allows early functionality of the graft. This, together with a living donor are considered good prognosis factors, moreover they reduce recipient mortality and improve graft lifetime.

Anesthesia and Kidney Transplant

Introduction: Chronic Kidney Disease (CKD) has diverse etiologies but regardless them the outcome changes when patients receive a renal transplantation, for most it has the potential to increase quality of life and improve survival. Since transplanted patients usually have co-morbid conditions, pre-surgical assessment, optimization of health status (premedication and pharmacological adjustment) monitoring and intraoperatory anesthetic management including anesthetic technique, drugs employed and hemodynamic stability are essential to achieve optimal function of the graft. Objective: to evaluate medical available literature concerning presurgical anesthetic assessment, intraoperatory and postoperatory anesthetic management of patients undergoing renal transplantation. Review Criteria: A bibliographic search was made in MEDLINE, OVID and LILIACS without language or design limits. Available evidences from February 1991 to February 2011 were taken. Articles about anesthesia in renal transplantation were included. Information quality was assessed according design type with “Critical Appraisal Skills Program” (CASP-UK) tools. Epidemiologic data of renal transplantation surgery in Colombia were obtained from Social Protection Ministry and FOSYGA pages. Results: Regarding prognosis, CKD mortality increases with dialysis (51%; RR: 0.51; CI 95% > 0.49-0.53; P < 0.001) and with its duration (22% if it is longer than 3 years and 3% it if less, P = 0, 01), whereas transplantation reduces it (31%; RR: 0.51; CI 95% > 0.49-0.53; P < 0.001) and enhances survival (P < 0.001). Receptor mortality, functionality and graft lifetime are influenced by donor type (immediate diuresis with live donors, P < 0,05), hydration (70 to 90 ml/Kg), early diuresis (13% of mortality at one year if delayed and reduction of graft lifetime 20 to 40%, p < 0.04). When comparing diuresis level and creatinin depuration, perfusion and renal function, there were no significant differences between general anesthesia and regional anesthesia (p > 0.05). Nevertheless, postoperatory analgesia was better with epidural anesthesia (p < 0.001). Conclusion: Thorough examination of the patient and optimization of the overall health status contributes to graft optimal function and patients' survival. Regional anesthesia has better control over postoperatory pain, but it has no effect on the prognosis. The intraoperatory maintenance of an appropriate hydration (60 - 90 ml/Kg) enhances flux and renal perfusion, which allows early functionality of graft. This, together with receiving the graft from a living donor are considered good prognosis factors, moreover they reduce receptor mortality, and improve graft lifetime Mesh:anesthesiology, general anesthesia, regional anesthesia, kidney transplantation, perioperative review, complication.

Combined Spinal-Epidural Anesthesia for Renal Transplantation

Combined Spinal-Epidural Anesthesia for Renal Transplantation

Réaction anaphylactique liée au latex probablement transmis par le greffon au cours d'une transplantation rénale

We report a case of a young man with an allergy to latex who developed anaphylactic shock during anaesthesia for renal transplantation. All anaesthetic agents used before the episode were tested as potential allergens and only latex was shown to be positive. It appears that latex contamination in the graft was the cause since no materials containing latex were used during the operation. We feel it essential that donor organs should be removed in a totally latex – free environment. Such conditions will remove the risk of anaphylactic shock at the point of reperfusion of the transplant.

Anesthesia for pediatric renal transplantation with and without epidural analgesia – a review of 7 years experience

Few objective data exist describing current anesthesia practice for pediatric renal transplantation. We describe here, the experience from an Australian tertiary pediatric center that has continued an active pediatric renal transplantation program after relocation in 1995. Areas of interest include preoperative status, fluid management, hemodynamic stability, perioperative complications, and the use of epidural analgesia. In particular, the influence of perioperative epidural analgesia on hemodynamic stability is addressed. A retrospective review of anesthesia records of all patients undergoing pediatric renal transplantation performed at the Children's Hospital at Westmead (CHW), from November 1995 to October 2002 was carried out. Fifty-three pediatric renal transplants were performed in 50 patients. Average age and weight were 10.2 years (range: 1-18 years) and 31.4 kg (range: 9-66 kg), respectively. A total of 14 recipients were less than or equal to 6 years of age. Twenty-four children were recipients of cadaveric transplants, 29 children received kidneys from living related donors. Few children presented with severe anemia (two patients) gross electrolyte abnormalities (three patients) or uncontrolled hypertension. Intraoperatively, all children had central venous pressure monitoring and only four had invasive arterial blood pressure monitoring. Average intraoperative fluid administration was 88 ml x kg(-1) (range: 30-190). Twenty-three children received blood transfusions intraoperatively. Postoperative analgesia was provided using an epidural infusion in 39 patients and an opioid infusion/patient controlled analgesia in the remainder. There was a tendency to greater hemodynamic stability in the group, which received intra-operative epidural analgesia. Half the patients who had epidural analgesia required parenteral opioid supplementation. Five patients had postoperative pulmonary edema. Minor postoperative adverse events included epidural associated motor block (three cases) and opioid related oversedation (one patient). No perioperative mortality or major morbidity was recorded. Anesthesia for renal transplantation in pediatric patients at CHW is safe and effective using a selected range of drugs and techniques. Pretransplant medical optimization, careful preoperative assessment, adequate monitoring and precise fluid management together with appropriate postoperative analgesia typify the perioperative care of CHW renal transplant recipients.

Clinical Assessment of Regional Anesthesia for Renal Transplantation

Background: Clinical studies suggest that postoperative morbidity and possibly mortality may be reduced when regional anesthesia is used. Use of regional anesthesia in renal transplantation is still controversial but promising. We assessed the effect of regional anesthesia for 20 cases of renal transplantation. Methods: 13 patients were operated on under subarachnoid block with continuous epidural anesthesia. Bupivacaine was used for subarachnoid block and lidocaine was used for continuous epidural anesthesia. 7 patients were operated on under only continuous epidural anesthesia. Lidocaine was used for only continuous epidural anesthesia. Results: In 20 cases of renal transplantation regional anesthesia was sufficient for performance of the operation. Stable intraoperative hemodynamics and absence of serious postoperative pulmonary complications were observed in patients operated on under regional anesthesia. Their postoperative analgesia was successfully maintained epidurally. Conclusions: Our cases show that regional anesthesia has the advantage of stable hemodynamics, fewer postoperative complications and postoperative analgesia.

ANAESTHETIC CHOICE IN RENAL TRANSPLANTATION: GENERAL OR EPIDURAL?

329 The use of continuous epidural anaesthesia in chronic renal failure patients is controversial but it is increasingly preferred in recent years. In this study our experience with epidural versus general anaesthesia in renal transplantation surgery is presented. After Ethics Committee approval, 46 adult patients (ASA 3) were studied in two groups. In group 1 (n23, general anaesthesia) anaesthesia was induced with thiopenthal, fentanyl, vecuronium and maintained with isoflurane, O2/N2O. In group 2 (n23, epidural anaesthesia), epidural anaesthesia was performed using 20 ml of bupivacaine 0.5% and fentanyl 50μg. At 2 hours of epidural induction, a 10 ml bolus of 0.5% bupivacaine was routinely given, and a 7 ml/h infusion of 0.25% bupivacaine was continued until the end of the operation. Patients were compared in respect to: (1) early postoperative haemodynamic variables (mean arterial pressures, heart rates), (2) renal function evaluated scintigraphically (perfusion, concentration and excretion) and biochemically (Na, K, BUN, Cr), (3) incidence of acute rejection and, (4) length of hospital stay. Demographic characteristics were similar between the groups. Though mean arterial pressures were in the hypertensive range in both groups at 3., 4., 5., and 6. hour postoperatively, they were lower in the epidural group (p<0.05). Changes in heart rates were similar between the groups. Renal function and the incidence of acute rejection were similar in two groups. Length of stay in hospital were shorter in epidural group (10,5±2,6 days) than in general anaesthesia group (12,9±3,9 days) (p<0.05). Appropriate anesthesia for renal transplantation requires minimal toxicity for the patient and the transplant, in addition to sufficient pain relief and maintenance of vital functions. Our results suggest the safe use of epidural anaesthesia with better control of arterial pressures in the early postoperative period and shorter length of stay in hospital than general anaesthesia. Thus it would seem logical to avoid the problems of general anesthesia in renal transplantation by using epidural anesthesia.

Anesthesia for Renal Transplantation in Children: 4 cases

Anesthesia for Renal Transplantation in Children: 4 cases

Anesthesia for Renal Transplantation

Renal transplantation is the preferred mode of replace ment therapy for most patients with end-stage renal disease (ESRD) and accounts for nearly 60% of all organ transplants in the United States. While as many as 35,000 people remain on the list waiting to receive a cadaveric kidney, living-related renal transplantation offers a shorter waiting period and greater survival. Maximization of the health of the kidney recipient before transplantation can improve ultimate outcome. Proper anesthetic management is facilitated by under standing the physiology and pharmacology of ESRD. Maintaining intraoperative blood volume is a key to good graft function, especially the living-related pediat ric kidney recipient. Recent improvements in combined immnosuppression therapy have improved the overall outcome in transplant recipients. The average 3-year survival is nearly 75%.

Assessment of Total Intravenous Anesthesia in Renal Transplantation

FOR renal transplantation, balanced anesthesia achieved with a combination of isoflurane, appropriate for uremic patients, N2O/O2, and fentanyl is frequently used. There are some disadvantages with this method, such as intraoperative hemodynamic instability due to hypoand hypervolemic periods during hemodialysis in hypertensive patients and late recovery. Total intravenous anesthesia (TIVA) using propofol and alfentanil seems to be a good alternative to balanced anesthesia for renal transplantation because of the short action of these drugs, the lack of change in their pharmacokinetics when used in uremic patients, the rapid recovery they afford, and their effective protection of intraoperative cardiovascular stability. The aim of this study was to evaluate the effects of TIVA on intraoperative hemodynamic stability and recovery in anesthesia during renal transplantation.

Anesthesia for renal transplantation: relaxants and volatiles.

Anesthesia for renal transplantation: relaxants and volatiles.

ANESTHESIA FOR RENAL TRANSPLANTATION

SUMMARY Renal transplantation has become a relatively common procedure that clinicians now offer to patients with an increasingly challenging array of medical problems; yet the mortality associated with anesthesia for renal transplantation remains low. Preoperative dialysis is of fundamental importance because it reverses many of the biochemical abnormalities caused by uremia. Modern anesthetic agents provide a greater margin of safety. There is no single or correct anesthetic for all patients with renal failure. With a clear understanding of the pharmacokinetics of anesthetic agents and an appreciation of the changes incurred by renal failure, a wide variety of agents can and have been used successfully. During renal transplantation, the anesthesiologist must optimize volume status, perfusion pressure, and other factors that affect the function and survival of the renal graft.

Sudden cardiorespiratory arrest after renal transplantation in a patient with diabetic autonomic neuropathy and prolonged QT interval

A 31-yr male with insulin dependent diabetes mellitus for 20 years underwent general anaesthesia for renal transplantation. During transfer from operating theatre to ICU he developed bradycardia advancing to ventricular fibrillation and had to be resuscitated. Bradycardia did not respond to atropine. Postoperative autonomic nervous function tests showed advanced autonomic neuropathy. He was found to have constantly prolonged QTc interval in his pre- and postoperative ECGs (462-503 ms). Prolongation of QTc interval could be used as a valuable predictor of postoperative cardiac complications in diabetic patients with autonomic neuropathy.

Anaesthesia for renal transplantation in sickle cell disease

Sickle cell disease (SCD) is associated with many pathological and functional abnormalities affecting all organ systems. Renal manifestations of SCD may result in end-stage renal disease (ESRD), which can be treated by chronic haemodialysis or renal transplantation. Renal transplantation was successfully performed in a 25-yr-old male with sickle cell beta-thalassaemia and nephrotic syndrome. We present a case report of this patient, a discussion of the renal complications associated with SCD and the perioperative management of a patient with SCD undergoing renal transplantation.

Haemodynamic responses during general anaesthesia for renal transplantation in patients with and without hypertensive disease

Haemodynamic changes in 81 patients undergoing surgery for renal transplantation were studied. They were allocated to three groups depending on whether or not they had chronic hypertension and which drugs were used to control it. The patients in Group I (N = 18, 22%) were normotensive and were not receiving antihypertensive therapy, those in Group II (N = 21, 26%) were taking beta-blockers and those in Group III (N = 42, 52%) both beta-blockers and vasodilating agents. Antihypertensive medication was continued as prescribed until surgery. No anticholinergic premedication was given. All patients received a standardized anaesthesia which included thiopentone, fentanyl, vecuronium and isoflurane. Mean arterial blood pressure and mean heart rate were lowest in Group I compared with the other groups immediately before induction, following vecuronium and thiopentone administration, and after tracheal intubation (P less than 0.05). After the 10-min induction period, blood pressure and heart rate values did not differ between the groups. Although before and during surgery and anaesthesia central venous pressure did not differ between the groups, CVP was higher in Group I postoperatively compared with the other groups (P less than 0.05). No serious anaesthesia-related complications occurred.