Anesthesia Complications in Renal Transplantation
Introduction. In a kidney transplant procedure the anesthesiologist is confronted with several pathophysiological changes inherent to the chronic nephropathy. There is a lack of consensus regarding the use of general vs. epidural anesthesia. The latter is a very important approach for postoperative pain control but many anesthesiologists avoid epidural anesthesia due to the risk of puncture-related complications in the light of the special characteristics of that patient population.
Objective. To describe the anesthetic management in renal transplant patients, the frequency of anesthetic complications and the mortality in the first 3 years of the renal transplantation program at the Neiva University Hospital.
Materials and methods. Case series of 54 patients undergoing renal transplantation at the Neiva University Hospital from January 2007 through September 2009.
Results. There were 21 women and 33 men in total, with a mean age of 42.2 years. 15 % had intraoperative complications, with a frequency of 11 % of hemodynamic instability, 1.9 respiratory depression, while 1.9 % experienced failed ex-tubation. 73 % received multimodal anesthesia. Epidural anesthesia was the most common approach for postoperative pain management (70 %) with morphine as the opioid of choice. Overall mortality was 7.4 %.
Conclusions. Multimodal anesthesia is a satisfactory option for patients undergoing renal transplantation. The epidural catheter is an attractive option to deliver both anesthesia and postoperative analgesia. Epidural opioids merit special attention because of their pharmacokinetic-derived risks, particularly those related to respiratory depression.
2. Linke CL. Anesthesia for renal transplantation. Bull NY Acad Med. 1980;56(5):458-66.
3. Bodziak KA. Recent trends in Kidney intraplantation. En: Hricik DE. Kidney intraplantation. London: Remedica; 2003. p. 1-13.
4. Youngberg JA, Hussey JL, Grogono AW, O'Neill WM, Frentz GD. Renal transplantation in a developing country: anesthesia and other considerations. South Med J. 1984;77(9):1095-7.
5. Bhagani S, Sweny P, Brook G; British HIV Association. Guidelines for kidney transplantation in patients with HIV disease. HIV Med. 2006;7(3):133-9.
6. Carmona P, Peleteiro A, Jimenez C, Gago S, Zaballos M. Anestesia con propofol, remifentanilo y cisatracu-rio en trasplante renal. Rev Esp Anestesiol Reanim. 2003;50(7): 356-9.
7. Pedersen T, Eliasen K, Henriksen E. A prospective study of risk factors and cardiopulmonary complications associated with anaesthesia and surgery: risk indicators of cardiopulmonary morbidity. Acta Anaesthesiol Scand. 1990;34(2):144-55.
8. Hariharan S, Johnson CP, Bresnahan BA, Taranto SE, McIntosh MJ, Stablein D. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342(9): 605-12.
9. SarinKapoor H, Kaur R, Kaur H. Anaesthesia for renal transplant surgery. Acta Anaesthesiol Scand. 2007;51(10):1354-67.
10. Djamali A, Becker YT, Simmons WD, Johnson CA, Premasathian N, Becker BN. Increasing hematocrit reduces early posttransplant cardiovascular risk in diabetic transplant recipients. Transplantation. 2003;76(5):816-20.
11. Goodman WG, Goldin J, Kuizon BD, Yoon C, Gales B, Sider D, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342(20):1478-83.
12. Bonilla A, Pedraza P, Guativa M. Aspectos perio-peratorios del trasplante renal. Rev Col Anest. 2007;35(1):67-74.
13. Elston AC, Bayliss MK, Park GR. Effect of renal failure on drug metabolism by the liver. Br J Anaesth. 1993;71(2):282-90.
14. Humar A, Kerr SR, Ramcharan T, Gillingham KJ, Matas AJ. Peri-operative cardiac morbidity in kidney transplant recipients: incidence and risk factors. Clin Transplant. 2001;15(3):154-8.
15. Hoke JF, Cunningham F, James MK, Muir KT, Hoffman WE. Comparative pharmacokinetics and pharmacodynamics of remifentanil, its principle metabolite (GR90291) and alfentanil in dogs. J Pharmacol Exp Ther. 1997;281(1):226-32.
16. Caralps A, Gil Veraet JM, Vives J, Andreu J, Brulles A, Tornos D, et al. Trasplante renal. Barcelona: Toray; 1983.
17. Eckardt KU. Cardiovascular consequences of renal anaemia and erythropoietin therapy. Nephrol Dial Transplant. 1999;14(5):1317-23.
18. Elston AC, Bayliss MK, Park GR. Effect of renal failure on drug metabolism by the liver. Br J Anaesth. 1993;71(2):282-90.
19. Cosio FG, Ailamir A, Yim S, Pesavento TE, Falkenhain ME, Henry ML. Patient survival after renal transplantation: the impact of dialysis pre-transplant. Kidney Int. 1998;53(3):767-72.
20. Prieto Duarte ML, Garza Rodríguez C, Elizondo Za-pien RM. Experiencia de 7 años de manejo anestésico en trasplante renal. Rev Arg Salud Publica y Nutrición. 2003;2:47-76.
21. Salifu MO, Markell MS. Evaluation of kidney intra-plant recipients and donors. En: Hricik DE. Kidney transplantation. London: Remedica; 2003. p. 55-75.
22. Valentín MO, Garrido G, Martín Escobar E, de la Rosa G, Mahillo B, Domínguez-Gil B, et al. Actividad de donación y trasplante renal en España 2006. Nefrología. 2007;27(4):434-8.
23. Burgos FJ. Presente y futuro del trasplante renal. Actas Urol Esp. 2002;26(10):731-62.
The publisher (Sociedad Colombiana de Anestesiología y Reanimación S.C.A.R.E.) retains copyright for the published articles.
Creative Commons License
Articles published by Colombian Journal of Anesthesiology are licensed under the Creative Commons 4.0 license: Attribution-NonCommercial-NoDerivs: CC BY-NC-ND.