Retrospective Analysis Of 108 Cases Renal Transplantation Anesthesia

Objective:The anaesthetic information of 108 cases who received renal transplantation in our hospital were retrospectively analyzed to comprehend the application of general anesthesia in kidney transplantation;,to explore the effects of different anesthesia regimens for kidney transplant patients , and to get the key points of anesthesia management .Methods:Anesthesic information of 108 patients who received renal transplantation from January 2006 to December 2008 were collected and analyzed. 45 cases of patients in early stage who were mainly applied with fentanyl,vecuronium, propofol and isoflurane, were classified as groupⅠ,63 cases of patients in latter stage who were applied with remifentanil, cis-atracurium, propofol and isoflurane as groupⅡ. Preoperative general condition of patients were analyzed. The effects of two anesthetic regimens on patient`s hemodynamics, extubation time, function of transplanted kidney,anesthesia complications and prognosis aslo were analyzed.Results:There is no significant difference between groups in general condition. MAP,CVP,HR were monitored and analysed in 108 patients at entering the operation room(T1),before opening of renal artery(T2),15 minutes after opening renal artery(T3), the end of surgery(T4) and extubation(T5) as the hemodynamics parameters. The effects of two anesthetic regimens showed no significant difference on hemodynamics(P>0.05). Hemodynamics parameters changed in the different surgery phase,The level of CVP and MAP at T3 were decreased significantly campared with CVP and MAP at T1,T2(P<0.05);the HR at T3 were faster significantly than HR at T1(P<0.05). The extubation time between two groups showed statistically significant differences (GroupⅠ: 47.5±26.2min; GroupⅡ: 33.5±17.5min). The effects of two anesthetic regimens showed no significant difference on Cre level and urinary volume. ( P>0.05 ) .The Cre level that after surgery decreased significantly compared with the Cre level before surgery (P<0.01). The urinary volume that after surgery improved significantly campared with the urinary volume before surgery(P<0.01).The frequent complication of anesthesia during renal transplantation were hypertension in recovery phase, restlessness in recovery phase,recovery delay , perioperative lung edema.The incidence of anesthesia complication between groups showed no difference(P>0.05). There were no death case in perioperative stage,but there were 7 death cases during hospital stay ,their causes of death were:Hepatic failure(2 cases), pulmonary infection(4 cases ),DIC(1case).Conclusion:Renal transplantation patients always have complex pre-operative condition and the general conditions were poor , so hemodialysis should be actively taken before surgery to correct anemia and environmental disorder,and to control the hypertension and infection,then improve patient's tolerance to anaesthesia and operation .Both of the two anesthetic regimens are provided to be safe for kidney transplantation. The degradation of Cisatracurium and remifentanil dose not rely on renal excretion, it might be a better anaesthesic regimen choice in renal transplantation. The common perioperative complications are hypertension in recovery stage, restlessness in recovery stage, post-anesthesia recovery delay and perioperative pulmonary edema,it has great significance for patient's security to actively prevent and deal with these anesthesia complications of renal transplantation patients during perioperative period.