General Anaesthesia for Renal Transplantation in Latvia: A Critical Analysis Based on Clinical Experience

Anaesthesia methods for surgical procedures, as well as for organ transplantation, have experienced remarkable changes over the past 40 years. Cadaveric renal transplant function may be impaired by haemodynamic instability induced by anaesthesia drugs. This study aimed to analyse the safety and effectiveness of the different anaesthesia methods used for renal transplantation in Latvia since 1973, with focus on its haemodynamic effects. In this retrospective study anaesthesia chart review was conducted for 607 patients (pts), aged 17-75 yrs, ASA III/IV, undergoing renal transplantation using general anaesthesia in the following periods: 1973-1990 (stage I - 282 pts); 1991-2000 (stage II - 145 pts); 2001-2011 (stage III - 180 pts). Haemodynamic data (systolic, diastolic, mean arterial blood pressure and central venous pressure) were measured prior to premedication and induction of anaesthesia, immediately afterwards, during the surgery and up to its completion with the special attention regarding the time of graft reperfusion. The main perioperative problems of the anaesthesia methods used during stage I (barbiturates, viadril, neuroleptanalgesics, sodium oxybutyrate, halothane, nitrous oxide) was haemodynamic instability in 60% of cases and apnea due to central depression and long-time peripheral neuromuscular blockade. Two patients died due to underlying comorbid conditions, including hyperhidration and oedema pulmonum. Substantial haemodynamic changes during total intravenous anaesthesia with propofol and combined anaesthesia propofol-isoflurane (stage II) were not observed. At the time of graft reperfusion, the incidence of hypotension was slightly higher in patients anaesthetised with isoflurane than in those who received sevoflurane (stage III), but this difference was not significant (P > 0.05). Kidney functioned immediately in 75% of cases and delayed function was observed in 25% of cases in sevoflurane and isoflurane groups. The modern anaesthetic agents provide a great margin of safety during renal transplantation. Total intravenous anaesthesia with midasolam-fentanyl-propofol and general anaesthesia with propofol-isoflurane, propofol-sevoflurane can be safely used. During renal transplantation, anaesthesiologists must optimise volume status, perfusion pressure and promote survival of the renal graft.