Anesthetic Management of End stage Renal Disease Planned for Renal Transplantation
Suzan Sayed Hafez Ahmed;
Abstract
Renal transplantation is the preferred treatment for end stage renal disease. Renal transplant anesthesia requires a thorough understanding of the metabolic and systemic abnormalities in end stage renal disease, familiarity with transplant medicine and expertise in managing and optimizing these patients for the best possible outcome.
End stage renal disease is a multisystem disease that affects many systems in the body including the cardiovascular, respiratory, central nervous system, and the gastrointestinal tract. It also disturbs the fluid and electrolyte balance in the body.
Kidney can be obtained from living donors, donors after brain or cardiac death. Transplantation from living healthy compatible donors carries the best prognosis.
Problems encountered by anesthetists in renal transplant recipients include hypertension, ischemic heart disease, congestive heart failure, anemia, metabolic acidosis, hyperkalemia, hyponatremia and circulatory collapse. Although solutions to most of these have been found over the past 50 years, the renal transplant procedure still carries significant risk of peri and postoperative complications (mostly cardiovascular) and even fatal outcome.
General anesthesia is the choice technique for renal transplantation, but several studies have shown that regional anesthesia can be used successfully and gives better postoperative analgesia. Kidney transplantation is a highrisk surgery; anesthetic and surgical techniques used should be carefully evaluated.
Intraoperative optimisation of blood volume and maintenance of adequate blood pressure holds the key in early success of transplanted kidney and thus an anesthesiologist plays a pivotal role in complete success of the surgery.
Immunosuppressive therapy is a key component for successful kidney transplantation. It is commonly believed that more intensive immunosuppression is needed initially to prevent rejection episodes and less immunosuppression is subsequently maintained to minimize the overall risk of infection and malignancy. The selection of drugs should be guided by a comprehensive assessment of the immunologic risk, patient comorbidities, financial cost, drug efficacy and adverse effects.
End stage renal disease is a multisystem disease that affects many systems in the body including the cardiovascular, respiratory, central nervous system, and the gastrointestinal tract. It also disturbs the fluid and electrolyte balance in the body.
Kidney can be obtained from living donors, donors after brain or cardiac death. Transplantation from living healthy compatible donors carries the best prognosis.
Problems encountered by anesthetists in renal transplant recipients include hypertension, ischemic heart disease, congestive heart failure, anemia, metabolic acidosis, hyperkalemia, hyponatremia and circulatory collapse. Although solutions to most of these have been found over the past 50 years, the renal transplant procedure still carries significant risk of peri and postoperative complications (mostly cardiovascular) and even fatal outcome.
General anesthesia is the choice technique for renal transplantation, but several studies have shown that regional anesthesia can be used successfully and gives better postoperative analgesia. Kidney transplantation is a highrisk surgery; anesthetic and surgical techniques used should be carefully evaluated.
Intraoperative optimisation of blood volume and maintenance of adequate blood pressure holds the key in early success of transplanted kidney and thus an anesthesiologist plays a pivotal role in complete success of the surgery.
Immunosuppressive therapy is a key component for successful kidney transplantation. It is commonly believed that more intensive immunosuppression is needed initially to prevent rejection episodes and less immunosuppression is subsequently maintained to minimize the overall risk of infection and malignancy. The selection of drugs should be guided by a comprehensive assessment of the immunologic risk, patient comorbidities, financial cost, drug efficacy and adverse effects.
Other data
| Title | Anesthetic Management of End stage Renal Disease Planned for Renal Transplantation | Other Titles | الاعتبارات التخديرية في تحضير حالات الفشــل الكلوي في مراحله النهائية لعمليات زرع الكلي | Authors | Suzan Sayed Hafez Ahmed | Issue Date | 2016 |
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