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Clinical Experience of Total Intravenous Anesthesia in 77 Renal Transplant Patients

Keywords: Total intravenous anesthesia , renal transplantation , propofol , remifentanil

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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<0.001). 57.1% of patients had no pain at 5. minutes postoperatively(Visual Analog Scale Score=0), at 15. minutes postoperatively mean visual analog scale score was 2.6 and the first analgesic requirements were recorded at 39.6 minutes. According to Ramsey Sedation Scale, majority of patients(54.5%) had response to commands at postoperative 5th minutes and 85.7% of patients were completely cooperative-oriented after 30 minutes. None of patients had deep sedation or respiratory depression. Conclusion:Total intravenous anesthesia can be considered as a safe method in patients with renal transplantation, may contribute to early postoperative recovery and transfer to the transplantation unit. [Cukurova Med J 2013; 38(4.000): 617-625]

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