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Clinical Experience of Total Intravenous Anesthesia in 77 Renal Transplant Patients

Year 2013, Volume: 38 Issue: 4, 627 - 635, 01.12.2013
https://doi.org/10.17826/cutf.55228

Abstract

Purpose:Renal transplantation significantly improves quality of life compared to hemodialysis in patients with end-stage renal failure. In end-stage renal failure anesthetic technique should be planned carefully, due to changes in volume distribution, drug metabolism, excretion. Results of total intravenous anesthesia, inhalation anesthesia, regional techniques are being investigated. Aim of this study was to present our experience in total intravenous anesthesia in 77 patients, who underwent live and cadaveric donor renal transplantation at Baskent University Faculty of Medicine Adana Teaching and Research Center. Material and Methods:Induction of anesthesia was performed with propofol(2mg/kg) and fentanyl(1μg/kg), and rocuronium bromide(0.4-0.5mg/kg) was given before intubation. Anesthesia was maintained with total intravenous anesthesia(propofol,50 mcg/kg/min; remifentanil,0.25 mcg/kg/min infusion). Intraoperative fluid, urine volumes were recorded. For preemptive multimodal analgesia, pre-incisional intravenous paracetamol(15mg/kg), intramuscular morphine(0.1mg/kg) were given. Postoperative analgesia was maintained with intravenous patient-controlled analgesia(meperidine 10 mg bolus, with a lockout time of 20 minutes). Postoperative pain was recorded using Visual Analogue Scale, level of sedation was assessed by Ramsey Sedation Scale. Results:Study included 64(83.1%) live donor transplantations and 13(16.9%) cadaveric donor transplantations. Mean total fluid administration was similar between live and cadaveric donor kidney transplantation patients however mean intraoperative urine output was significantly higher in live donor kidney transplantation patients(p

References

  • Murray JE. Ronald Lee Herrick Memorial: June 15, 1931-December 27, 2010. Am J Transplant. 2011; 11: 4
  • Sprung J, Kapural L, Bourke DL and O'Hara JF. Anesthesia for kidney transplant surgery. Anesthesiol Clin North America. 2000; 18: 919-51.
  • Brown JH, Hunt LP, Vites NP, Short CD, Gokal R and Mallick NP. Comparative mortality from cardiovascular disease in patients with chronic renal failure. Nephrol Dial Transplant. 1994; 9: 1136-42.
  • Mathew A, Devereaux PJ, O'Hare A, Tonelli M, Thiessen-Philbrook H and Nevis IFP. Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int. 2008; 73: 1069Nichols D and Nielsen ND. Oxygen delivery and consumption: a macrocirculatory perspective. Crit Care Clin. 2010; 26: 239-53.
  • Trainor D, Borthwick E and Ferguson A. Perioperative management of the hemodialysis patient. Semin Dial. 2011; 24: 314-26.
  • Byrick RJ. Anesthesia and end stage renal failure: is TIVA an advance? Can J Anaesth. 1999; 46: 621-2.
  • Ickx B, Cockshott ID, Barvais L, Byttebier G, De Pauw L and Vandesteene A. Propofol infusion for induction and maintenance of anaesthesia in patients with end-stage renal disease. Br J Anaesth. 1998; 81: 854
  • Hoke JF, Shlugman D, Dershwitz M, Michałowski P, Malthouse-Dufore S and Connors PM. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology. 1997; 87: 533Dahaba AA, Oettl K, von Klobucar F, Reibnegger G and List WF. End-stage renal failure reduces central clearance and prolongs the elimination half life of remifentanil. Can J Anaesth. 2002; 49: 369-74.
  • Modesti C, Sacco T, Morelli G, Bocci MG, Ciocchetti P and Vitale F. Balanced anestesia versus total intravenous anestesia for kidney transplantation. Minerva Anestesiol. 2006; 72: 627-35.
  • Dahaba AA, von Klobucar F, Rehak PH and List WF. Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure. Can J Anaesth. 1999; 46: 696-700.
  • Sparr HJ, Beaufort TM and Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents? Drugs. 2001; 61: 919McCourt KC, Salmela L, Mirakhur RK, Carroll M, Mäkinen MT and Kansanaho M. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998; 53: 867-71.
  • Craig RG and Hunter JM. Neuromuscular blocking drugs and their antagonists in patients with organ disease. Anaesthesia. 2009; 64: 55-65.
  • Kocabas S, Yedicocuklu D and Askar FZ. The neuromuscular effects of 0.6 mg kg(-1) rocuronium in elderly and young adults with or without renal failure. Eur J Anaesthesiol. 2008; 25: 940-6.
  • Lazowski T. The influence of the type of anaesthesia on postoperative pain after kidney transplantation. Ann Transplant. 2000; 5: 28-9.
  • Yuzbasioglu MF, Aykas A, Kurutas EB and Sahinkanat T. Protective effects of propofol against ischemia/reperfusion injury in rat kidneys. Ren Fail. 2010; 32: 578-83.
  • Pérez Valdivia MA, Gentil MA, Toro M, Cabello M, Rodríguez-Benot A and Mazuecos A. Impact of cold ischemia time on initial graft function and survival rates in renal transplants from deceased donors performed in Andalusia. Transplant Proc. 2011; 43: 2174Carlier M, Squifflet JP, Pirson Y, Gribomont B and Alexandre GP. Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants. Transplantation. 1982; 34: 201-4.
  • Wilson WC and Aronson S. Oliguria. A sign of renal success or impending renal failure? Anesthesiol Clin North America. 2001; 19: 841-83.
  • Campos L, Parada B, Furriel F, Castelo D, Moreira P and Mota A. Do intraoperative hemodynamic factors of the recipient influence renal graft function? Transplant Proc. 2012; 44: 1800-3.
  • Liu SS. Effects of Bispectral Index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004; 101: 311-5.
  • Gan TJ, Glass PS, Windsor A, Payne F, Rosow C and Sebel P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997; 87: 808
  • Satisha M, Sanders GM, Badrinath MR, Ringer JM and Morley AP. Introduction of bispectral index monitoring in a district general hospital operating suite: a prospective audit of clinical and economic effects. Eur J Anaesthesiol. 2010; 27: 196-201.
  • Yazışma Adresi / Address for Correspondence: Dr. Pınar Ergenoğlu Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi Anesteziyoloji ve Reanimasyon AD. Yüreğir/ADANA e-mail: pergenoglu@yahoo.com geliş tarihi/received :24.09.2013 kabul tarihi/accepted:07.12.2013

Renal Transplantasyon Yapılan 77 Hastada Total İntravenöz Anestezi Deneyimimiz

Year 2013, Volume: 38 Issue: 4, 627 - 635, 01.12.2013
https://doi.org/10.17826/cutf.55228

Abstract

Amaç: Renal transplantasyon son dönem böbrek yetmezliği hastalarında hemodiyalizle karşılaştırıldığında yüksek yaşam kalitesi sağlayan bir yöntemdir. Son dönem böbrek yetmezliğinde volüm dağılımı, ilaç metabolizması, atılımındaki değişiklikler nedeniyle anestezi tekniği özenle planlanmalıdır. Total intravenöz anestezi, inhalasyon anestezisi, rejyonel tekniklerin sonuçları araştırılmaktadır. Çalışmada Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi"nde canlı ve kadaverik donörden renal transplantasyon uygulanan 77 hastada total intravenöz anestezi deneyimimizin aktarılması amaçlanmıştır. Materyal ve Metod: Anestezi indüksiyonu propofol 2mg/kg, fentanil 1µg/kg ile sağlandı, roküronyum bromürle (0.4-0.5mg/kg) entübasyon gerçekleştirildi. İdame total intravenöz anesteziyle (propofol, 50µg/kg/dk; remifentanil, 0.25µg/kg/dk infüzyon) sağlandı. İntraoperatif sıvı, idrar miktarı kaydedildi. Preemptif multimodal analjezide preinsizyonel 15mg/kg intravenöz parasetamol, 0.1mg/kg intramüsküler morfin uygulandı. Postoperatif analjezide intravenöz hasta kontrollü (meperidin 10mg bolus, kilitli kalma süresi 20 dakika) kullanıldı. Postoperatif ağrı vizüel analog skala, sedasyon düzeyleri Ramsey Sedasyon Skalası kullanılarak kaydedildi. Bulgular: Canlı donörden transplantasyon sayısı 64(83.1%), kadaverik donörden transplantasyon sayısı 13 (16.9%) idi. Canlı ve kadaverik donörden böbrek transplantasyonu yapılan hastalarda intraoperatif verilen mayi miktarında istatistiksel olarak anlamlı fark gözlenmezken; intraoperatif çıkarılan idrar miktarının canlı donörden böbrek nakli uygulanan hastalarda anlamlı olarak yüksek olduğu saptandı(p

References

  • Murray JE. Ronald Lee Herrick Memorial: June 15, 1931-December 27, 2010. Am J Transplant. 2011; 11: 4
  • Sprung J, Kapural L, Bourke DL and O'Hara JF. Anesthesia for kidney transplant surgery. Anesthesiol Clin North America. 2000; 18: 919-51.
  • Brown JH, Hunt LP, Vites NP, Short CD, Gokal R and Mallick NP. Comparative mortality from cardiovascular disease in patients with chronic renal failure. Nephrol Dial Transplant. 1994; 9: 1136-42.
  • Mathew A, Devereaux PJ, O'Hare A, Tonelli M, Thiessen-Philbrook H and Nevis IFP. Chronic kidney disease and postoperative mortality: a systematic review and meta-analysis. Kidney Int. 2008; 73: 1069Nichols D and Nielsen ND. Oxygen delivery and consumption: a macrocirculatory perspective. Crit Care Clin. 2010; 26: 239-53.
  • Trainor D, Borthwick E and Ferguson A. Perioperative management of the hemodialysis patient. Semin Dial. 2011; 24: 314-26.
  • Byrick RJ. Anesthesia and end stage renal failure: is TIVA an advance? Can J Anaesth. 1999; 46: 621-2.
  • Ickx B, Cockshott ID, Barvais L, Byttebier G, De Pauw L and Vandesteene A. Propofol infusion for induction and maintenance of anaesthesia in patients with end-stage renal disease. Br J Anaesth. 1998; 81: 854
  • Hoke JF, Shlugman D, Dershwitz M, Michałowski P, Malthouse-Dufore S and Connors PM. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology. 1997; 87: 533Dahaba AA, Oettl K, von Klobucar F, Reibnegger G and List WF. End-stage renal failure reduces central clearance and prolongs the elimination half life of remifentanil. Can J Anaesth. 2002; 49: 369-74.
  • Modesti C, Sacco T, Morelli G, Bocci MG, Ciocchetti P and Vitale F. Balanced anestesia versus total intravenous anestesia for kidney transplantation. Minerva Anestesiol. 2006; 72: 627-35.
  • Dahaba AA, von Klobucar F, Rehak PH and List WF. Total intravenous anesthesia with remifentanil, propofol and cisatracurium in end-stage renal failure. Can J Anaesth. 1999; 46: 696-700.
  • Sparr HJ, Beaufort TM and Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents? Drugs. 2001; 61: 919McCourt KC, Salmela L, Mirakhur RK, Carroll M, Mäkinen MT and Kansanaho M. Comparison of rocuronium and suxamethonium for use during rapid sequence induction of anaesthesia. Anaesthesia. 1998; 53: 867-71.
  • Craig RG and Hunter JM. Neuromuscular blocking drugs and their antagonists in patients with organ disease. Anaesthesia. 2009; 64: 55-65.
  • Kocabas S, Yedicocuklu D and Askar FZ. The neuromuscular effects of 0.6 mg kg(-1) rocuronium in elderly and young adults with or without renal failure. Eur J Anaesthesiol. 2008; 25: 940-6.
  • Lazowski T. The influence of the type of anaesthesia on postoperative pain after kidney transplantation. Ann Transplant. 2000; 5: 28-9.
  • Yuzbasioglu MF, Aykas A, Kurutas EB and Sahinkanat T. Protective effects of propofol against ischemia/reperfusion injury in rat kidneys. Ren Fail. 2010; 32: 578-83.
  • Pérez Valdivia MA, Gentil MA, Toro M, Cabello M, Rodríguez-Benot A and Mazuecos A. Impact of cold ischemia time on initial graft function and survival rates in renal transplants from deceased donors performed in Andalusia. Transplant Proc. 2011; 43: 2174Carlier M, Squifflet JP, Pirson Y, Gribomont B and Alexandre GP. Maximal hydration during anesthesia increases pulmonary arterial pressures and improves early function of human renal transplants. Transplantation. 1982; 34: 201-4.
  • Wilson WC and Aronson S. Oliguria. A sign of renal success or impending renal failure? Anesthesiol Clin North America. 2001; 19: 841-83.
  • Campos L, Parada B, Furriel F, Castelo D, Moreira P and Mota A. Do intraoperative hemodynamic factors of the recipient influence renal graft function? Transplant Proc. 2012; 44: 1800-3.
  • Liu SS. Effects of Bispectral Index monitoring on ambulatory anesthesia: a meta-analysis of randomized controlled trials and a cost analysis. Anesthesiology. 2004; 101: 311-5.
  • Gan TJ, Glass PS, Windsor A, Payne F, Rosow C and Sebel P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997; 87: 808
  • Satisha M, Sanders GM, Badrinath MR, Ringer JM and Morley AP. Introduction of bispectral index monitoring in a district general hospital operating suite: a prospective audit of clinical and economic effects. Eur J Anaesthesiol. 2010; 27: 196-201.
  • Yazışma Adresi / Address for Correspondence: Dr. Pınar Ergenoğlu Başkent Üniversitesi Tıp Fakültesi Adana Uygulama ve Araştırma Merkezi Anesteziyoloji ve Reanimasyon AD. Yüreğir/ADANA e-mail: pergenoglu@yahoo.com geliş tarihi/received :24.09.2013 kabul tarihi/accepted:07.12.2013
There are 22 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Pınar Ergenoğlu This is me

Çağla Bali This is me

Şule Akın This is me

Nesrin Bozdoğan Özyılkan This is me

Hacer Ülger This is me

Anış Arıboğan This is me

Publication Date December 1, 2013
Published in Issue Year 2013 Volume: 38 Issue: 4

Cite

MLA Ergenoğlu, Pınar et al. “Renal Transplantasyon Yapılan 77 Hastada Total İntravenöz Anestezi Deneyimimiz”. Cukurova Medical Journal, vol. 38, no. 4, 2013, pp. 627-35, doi:10.17826/cutf.55228.