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 experiencedremarkable changes over the past 40 years. cadaveric renal transplant function may beimpaired by haemodynamic instability induced by anaesthesia drugs. this study aimed to analysethe safety and effectiveness of the different anaesthesia methods used for renal transplantation inlatvia since 1973, with focus on its haemodynamic effects. in this retrospective study anaesthesiachart review was conducted for 607 patients (pts), aged 17–75 yrs, asa iii/iv, undergoing renaltransplantation using general anaesthesia in the following periods: 1973–1990 (stage i – 282pts); 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 topremedication and induction of anaesthesia, immediately afterwards, during the surgery and up toits completion with the special attention regarding the time of graft reperfusion. the mainperioperative problems of the anaesthesia methods used during stage i (barbiturates, viadril,neuroleptanalgesics, sodium oxybutyrate, halothane, nitrous oxide) was haemodynamic instabilityin 60% of cases and apnea due to central depression and long-time peripheral neuromuscularblockade. two patients died due to underlying comorbid conditions, including hyperhidration andoedema pulmonum. substantial haemodynamic changes during total intravenous anaesthesiawith propofol and combined anaesthesia propofol-isoflurane (stage ii) were not observed. at thetime of graft reperfusion, the incidence of hypotension was slightly higher in patientsanaesthetised with isoflurane than in those who received sevoflurane (stage iii), but this differencewas not significant (p > 0.05). kidney functioned immediately in 75% of cases and delayedfunction was observed in 25% of cases in sevoflurane and isoflurane groups. the modern anaestheticagents provide a great margin of safety during renal transplantation. total intravenous anaesthesiawith midasolam-fentanyl-propofol and general anaesthesia with propofol-isoflurane,propofol-sevoflurane can be safely used. during renal transplantation, anaesthesiologists mustoptimise volume status, perfusion pressure and promote survival of the renal graft.