lunes, 24 de noviembre de 2014

Transplante renal/Kidney transplant

Manejo anestésico del transplante renal en pacientes con cardiomiopatía dilatada con fracción de eyección menor del 40%

Anaesthetic management of renal transplant surgery in patients of dilated cardiomyopathy with ejection fraction less than 40%.
Srivastava D, Tiwari T, Sahu S, Chandra A, Dhiraaj S.
Anesthesiol Res Pract. 2014;2014:525969. doi: 10.1155/2014/525969. Epub 2014 Aug 19.
Cardiovascular disease (CVD) is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the clinicians who care for chronic kidney disease patients. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, and dyslipidemia) in this patient population. Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. Herein we provide a series of eight patients with dilated cardiomyopathy with poor ejection fraction posted for live donor renal transplantation which was successfully performed under regional anesthesia with sedation.

Anestesia para transplante renal laparoscópico. Influencia de la posición de Trendelenburg y del pneumoperitoneo con C02 sobre la función cardiovascular, respiratoria y renal

Anaesthesia for laparoscopic kidney transplantation: Influence of Trendelenburg position and CO2 pneumoperitoneum on cardiovascular, respiratory and renal function.
Parikh BK, Shah VR, Modi PR, Butala BP, Parikh GP.
Indian J Anaesth. 2013 May;57(3):253-8. doi: 10.4103/0019-5049.115607.
BACKGROUND: Laparoscopic donor nephrectomy is a routine practice since 1995. Until now, the recipient has always undergone open surgery fortransplantation. In our institute, laparoscopic kidney transplantation (LKT) started in 2010. To facilitate this surgery, the patient must be in steep Trendelenburg position for a long duration. Hence, we decided to study the effect of CO2 pnuemoperitoneum and Trendelenburg position in chronic renal failure (CRF) patients undergoing LKT. METHODS: A total of 20 adult CRF patients having mean age of 31.7±10.36 years and body mass index 19.65±3.41 kg/m(2) without significant coronary artery disease were selected for the procedure. Cardiovascular parameters heart rate (HR), mean arterial pressure (MAP), Central venous pressure (CVP) and respiratory parameters (ETCO2, peak airway pressure) were noted at the time of induction, after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position, 15 min after decompression of pnuemoperitonuem and after extubation. Arterial blood gas analysis was carried out after induction, 15 min after creation of pnuemoperitoneum, 30 min after Trendelenburg position and 15 min after clamp release. Total duration of surgery, anastomosis time, time for the establishment of urine output and total urine output were noted. Serum creatinine on the 1(st) and 7(th) post-operative day were recorded. RESULTS:Significant increase in HR was observed after creation of CO2 pneumoperitoneum and just before extubation. Significant increase in the MAP and CVP was noted after creation of pneumoperitoneum and after giving Trendelenburg position. No significant rise in the ETCO2 and PaCO2 was observed. Significant increase in the base deficit was observed after the clamp release, but none of the patients required correction.
CONCLUSION: LKT performed in steep Trendelenburg position with CO2 pneumoperitoneum significantly influenced cardiovascular and respiratory homeostasis; however, measured parameters remained within clinically acceptable range without affecting early function of the transplanted kidney.
KEYWORDS:CO2 pneumoperitoneum; Trendelenburg position; laparoscopic kidney transplantation;year=2013;volume=57;issue=3;spage=253;epage=258;aulast=Parikh;type=2

Anestesiología y Medicina del Dolor
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