Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000200004
Brazilian Journal of Anesthesiology
Scientific Article

Influência da técnica anestésica nas alterações hemodinâmicas no transplante renal: estudo retrospectivo

Influence of the anesthetic technique on the hemodynamic changes in renal transplantation: a retrospective study

Eunice Sizue Hirata; Maria Fernanda Baghin; Rosa Inês Costa Pereira; Gentil Alves Filho; Artur Udelsmann

http://dx.doi.org/10.1590/S0034-70942009000200004 Braz J Anesthesiol, vol.59, n2, p.166-176, 2009
PDF Português
PDF English
Downloads: 1
Views: 962

Resumo

JUSTIFICATIVA E OBJETIVOS: Sucesso no transplante renal (Tx) depende do tipo de doador, da duração da isquemia fria e de parâmetros hemodinâmicos na reperfusão. O objetivo desta pesquisa foi analisar a técnica anestésica, a incidência de alterações cardiovasculares e a ocorrência de diurese no período perioperatório dos Tx realizados na UNICAMP. MÉTODO: Avaliou-se retrospectivamente Tx de adultos realizados entre janeiro de 2005 e abril de 2006. Consideraram-se dados demográficos, exames laboratoriais pré-operatórios, técnicas e agentes anestésicos, hidratação, parâmetros hemodinâmicos, emprego de aminas vasoativas, presença de diurese e complicações intra-operatórias, com análise comparativa entre os subgrupos formados conforme a técnica anestésica empregada. Foram usados na análise estatística o teste t de Student (paramétricos), Mann-Whitney (não paramétricos), teste do Qui-quadrado e Exato de Fisher para comparação de proporções e análise multivariada. RESULTADOS: Estudaram-se 92 pacientes, 59 com anestesia geral (AG) e 33 anestesia geral associada à peridural (AG + Peri), 42 receberam rim de doadores vivos e 50 de falecidos. Não houve diferença (p > 0,05) na maioria dos parâmetros pré-operatórios estudados, exceção feita à origem do enxerto (82% AG + Peri receberam rins de doador falecido). A alteração cardiovascular mais frequente foi hipotensão arterial (30% AG e 48% AG + Peri, p < 0,05). Regime de hidratação não diferiu entre os grupos (86,7 ± 30,2 mL.kg-1 AG e 94,8 ± 21,8 mL.kg-1 AG+Peri, p = 0,38). Enxerto de doador falecido correlacionou-se a maior instabilidade hemodinâmica e pior prognóstico para função imediata do enxerto, p < 0,01 e 0,01, respectivamente. Volume de hidratação de 80 mL.kg-1 associou-se à diurese (OR = 2,94, IC95% 1,00-8,32). CONCLUSÕES: A técnica anestésica empregada foi anestesia geral, associada ou não à peridural. Alteração hemodinâmica mais comum foi hipotensão arterial. Mostraram-se benéficos em relação à diurese ser receptor de doador vivo e receber hidratação de 80 mL.kg-1 de solução fisiológica a 0,9%.

Palavras-chave

CIRURGIA, Urológica, COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: The success of renal transplantation (Tx) depends on the type of donor, length of cold ischemia, and hemodynamic parameters on reperfusion. The objective of this study was to analyze the anesthetic technique, the incidence of cardiovascular changes, and the presence of postoperative diuresis of Tx performed at UNICAMP. METHODS: Renal transplantation of adults performed from January 2005 and April 2006 were evaluated retrospectively. Demographic data, preoperative laboratorial exams, anesthetic techniques and agents, hydration, hemodynamic parameters, use of vasoactive amines, presence of a diuresis, and intraoperative complications were evaluated, and comparative analysis between the subgroups, formed according to the anesthetic technique, was undertaken. The Student t test (parametric), Mann-Whitney test (non-parametric), Chi-square test and Fisher Exact test for comparison of proportions and multivariate analysis were used. RESULTS: Ninety-two patients were evaluated; 59 underwent general anesthesia (GA) and 33 underwent general anesthesia associated with epidural block (GA + Epi); 42 patients received live-donor transplants and 50 from dead donors. Most preoperative parameters analyzed did not show statistically significant differences (p > 0.05), except for the origin of the graft (82% of GA + Epi received dead donor kidneys). Hypotension (30% GA and 48% GA + Epi, p < 0.05) was the most frequent cardiovascular change. The hydration regimen did not differ between both groups (86.7± 30.2 mL.kg-1 GA and 94.8 ± 21.8 mL.kg-1 GA+Epi, p = 0.38). Dead donor grafts were more commonly associated with hemodynamic instability and worse prognosis for the immediate function of the graft, p < 0.01 and 0.01, respectively. Hydration of 80 mL.kg-1 was associated with the presence of diuresis (OR = 2.94, CI 95% 1.00-8.32). CONCLUSIONS: General anesthesia associated or not with epidural block was the anesthetic technique used. Hypotension was the most common hemodynamic change. Live-donor graft and volume of hydration of 80 mL.kg-1 of NS favored diuresis.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, SURGERY, Urologic

Referências

Stockall C, Amante AJ, Kahan B. Renal transplantation. Anesthesia and Transplantation. 1999:241-274.

Lima MG. Avaliação e Seleção Imunológica: Prova Cruzada, Reatividade contra Painel e Tipificação HLA. Manual de Transplante Renal. 2004:23-24.

Wolfe RA, Ashby VB, Milford EL. Comparison of mortality in all patients on dialysis, patients awaiting transplantation and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725-1730.

So SK, Chang PN, Najarian JS. Growth and development in infant after renal transplantation. J Pediatr. 1987;110:343-350.

Hunter JM, Jones RS, Utting JE. Use of atracurium in patients with no renal function. Br J Anaesth. 1982;54:1251-1258.

Spencer EM, Willatts SM, Prys-Roberts C. Plasma inorganic fluoride concentrations during and after prolonged (>24hs) isoflurane sedation: effect on renal function. Anesth Analg. 1991;73:731-737.

Heino A, Orko R, Rosenberg PH. Anaesthesiological complications in renal transplantation: a retrospective study on 500 transplantation. Acta Anaesthesiol Scand. 1986;30:574-580.

Carlier M, Squifflet JP, Pirson Y. Maximal hydration during anesthesia increases pulmonary artery pressures and improves early function of human renal transplant. Transplantation. 1982;34:201-204.

Luciani J, Frantz P, Thibault P. Early anuria prevention in human kidney transplantation: Advantage of fluid load under pulmonary artery pressure monitoring during surgical period. Transplantation. 1979;28:308-312.

Moote CA. Anesthesia for renal transplantation. Anesthesiol Clin North America. 1994;12:691-715.

Williams M, Milner QJ. Posoperative analgesia following renal transplantation: current practice in UK. Anaesthesia. 2003;58:712-713.

Angst MS, Buher M, Lotsch J. Insidious intoxication after morphine treatment in renal failure: delayed onset of morphine-6-glucuronide action. Anesthesiology. 2000;92:1473-1476.

Akpek E, Kayhan Z, Kaya H. Epidural anesthesia for renal transplantation: a preliminary report. Transplant Proc. 1999;31:3149-3150.

Hadimioglu N, Ertug Z, Bigat Z. A randomized study comparing combined spinal epidural or general anesthesia for renal transplantation surgery. Transplant Proc. 2005;37:2020-2022.

Basta M, Sloan P. Epidural hematoma following epidural catheter placement in a patient with chronic renal falure. Can J Anaesth. 1999;46:271-274.

Zachee P, Vermylen J, Boogaerts MA. Hematologic aspects of end stage renal failure. Ann Hematol. 1994;69:33-40.

Ferrari F, Nascimento Jr P, Vianna PTG. Complet atrioventricular block during renal transplantation in patient with Alport's Síndrome: case report. São Paulo Med J. 2001;119:184-186.

Mota A, Freitas L, Marcio F. Risk Factors for acute tubular necrosis in 774 cadaver renal transplantations. Braz J Urol. 2002;28:93-101.

Coriat P, Richer C, Douraki T. Influence of chronic angiotensin converting enzyme inhibition on anesthetic induction. Anesthesiology. 1994;81:299-307.

Katz DV, Troster EJ, Vaz FAC. Dopamina e o rim na sepse: uma revisão sistemática. Rev Assoc Med Bras. 2003;49:317-326.

Dawidson IJ, Ar'Rajab A. Perioperative Fluid and Drug Therapy during Cadaver Kidney Transplantation. Clinical Transplants. 1992:267-279.

O'Brien EA, Bour SA, Marshall RL. Effect of use of vasopressors in organ donors on immediate function of renal allografts. J Transpl Coord. 1996;6:215-216.

Dawidson I, Ar'Rajab A, Dickerman R. Perioperative albumin and verapamil improve early outcome after cadaver renal transplantation. Transplant Proc. 1994;26:3100-3101.

Schnuelle P, van der Woude FJ. Perioperative fluid management in renal transplantation: a narrative review of literature. Transpl Int. 2006;19:947-959.

Caldwell JE, Cook DR. Kidney Transplantation. Anesthetic Principles of Organ Transplantation. 1994:183-228.

Carlier M, Squifflet JP, Pirson Y. Anesthetic protocol in human renal transplantation: twenty-two years of experience. Acta Anaesthesiol Belg. 1986;37:89-94.

Dawidson IJ, Sandor ZF, Coorpender L. Intraoperative albumina administration affects the outcome of cadaver renal transplantation. Transplantation. 1992;53:774-782.

5dd686d80e8825ec4bc8fca6 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections