Anesthesia for Renal Transplantation - Report of 24 Cases

Kim, Sung Nyeun; Kim, Kap Sung; Yoo, Jee Sop; Chung, Tae Ho; Chon, Se Ung; Chung, Woon Hyok

Abstract

This is a report of anesthesia done for 24 cases of renal transplantation performed at St. Mary's Hospital, Catholic Medical college, Seoul, Korea, between 25 March 1969 and 19 August 1976. The recipient of renal transplantation show many critical conditions which require special considerations in performing anesthesia. The patients preoperative condition should be evaluated more carefully than most other kinds of surgical patients and anesthesia technic also must be selected specially. All kidney grafts were obtained from living donors. The family linkage of 24 donors was: 7 cases(29.1%) were from parents, 3 cases(12.5%) from children, 9 cases (37.5%) from siblings, 3 cases(12. 5%) from other relatives and 2 cases (8. 3%) were from nonrelated prsons. In the sex distribution of the donors, each sex was equally distributed.: All donors were anesthetized by means of endotracheal anesthesia using halothane, nitrous oxide and oxygen. As to complications during the nephrectomy of donors, a case of hiccup and two cases of pleural tear were encountered. The removed kidney was perfused with Hartmanns solution before transplantation and the choice of anesthetic agents caused no problems in the function of transplanted kidneys. The recipients had histories of chronic glomerulozephritis or pyelonephritis from 6 months to 32 years and showed uremic conditions. Their mean age was 38 years, ranging from 18 years to 59 years. The most frequent age group of the recipients was the 30 and 40 year group. Most recipients were males; among 24 cases, only 3 were females. Most of the recipients had decreased function of heart and lungs, severe anemia difficult to correct by blood transfusion(Hb, 7. 3 gm%, Hct. 24, 2%), increased BUN(70. 36+/-31. 34 mg/dl), hyperkalemia (4. 67+/-0. 63 mEq/L), poor and fragile veins, bleeding tendency and decreased kidney function(serum creatinine 10. 48 edmea, +/-2. 99 mg/dl). Prolonged medication to the recipient was another hazard to anesthesia. To lessen the risk during the anesthesia maintenance, preoperative preperation of the recipient The Journal of The Korean Society of Anesthesiologists Vol. 10, No. 1, 1977 Premedication of the recipients was perfor med by valium(515 mg) and atropine(0. 4 0. 5 mg) one hour before anestl esia. For tlie anesthetic technic, endotracheal anesthesia was applied to aI1 cases. Induction was done with intravenous pentothal soium, l00~ 200 mg or Epontol 250~500mg. As to the muscle relaxant to facilitate intubation, succinylchline for ll cases of the initial period of the transplantation, later gallamine for one case and pancuronium for the recent 12 cases. All anesthesia was maintained with halothane, nitrous oxide and oxygen. Muscle relaxants were used in al) cases during the surgery: succinylcholine drip for the initial 7 cases, d-Tubocurarine for 2 cases, gallamine for 2 cases and pancuronium for the recent 12 cases. Galllamine seems to be not contraindicated, as far as the active diuresis could be anticipated after the transplantation. Amount of blood transfused during operation was 2, 041 ml in average, ranging from 800 ml to 5000 ml and fluid infused was 1, 242 m] of Hartmann's sol. and/or other solutions. Respiration was controlled manually or mechanically. During the anesthesia, 16 cases of hypertension, 7 cases of arterial hypotension, 3 cases of arrhythmia, one cas of tight chest and one case of tachycardia, were encountered. Emergence of anesthesia was within 15 minutes. After the transplantation, diuresis started in 33 minutes on the average and most patients showed marked diuresis in which urine volume of 24 hours was 10, 164 ml on the average. The total surgical procedure lasted 4 hours and 50 minutes on the average, ranging from 3 hours 50 minutes to 7 hours. The ischemic tine of the removed kidney was 32 minutes in average. Followup of the patients showed that 10 cases died out of 24 cases between 4 months and 4 years after the surgery Patients surviving more than 1 year were 11 cases out of 15 cases(73. 3%), two cases out of 8 cases(25%) survived more than 2 years and two cases out of 8 cases(25%) more than 3 years. One case had the longest survival of 7 1/3 years.

Anesthesia for Renal Transplantation - Report of 24 Cases

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