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Combined spinal-epidural anesthesia for renal transplantation.
Transplant Proc. 2008 May; 40(4):1122-4.TP

Abstract

INTRODUCTION

A patient undergoing renal transplantation presents unique problems to the anesthetist, as almost every body system is affected. The combined spinal-epidural technique has become popular in lower abdominal surgeries because it offers the advantages of both spinal and epidural techniques. We review our experience of combined spinal-epidural technique in patients undergoing renal transplantation with respect to demographics, intraoperative anesthesia, hemodynamics, postoperative analgesia, and untoward adverse events.

MATERIALS AND METHOD

Fifty consecutive patients scheduled for elective renal transplantation over a period of 4 months who consented for combined spinal-epidural anesthesia were enrolled in the study. Combined spinal-epidural anaesthesia was performed using a double-space technique in the right lateral position. Intraoperative monitoring included electrocardiography, pulse oximetry, noninvasive blood pressure, central venous pressure, and urinary output after clamp release. Intravenous fluids, colloids, and blood products were infused so as to keep the central venous pressure between 12 and 15 mm Hg. Postoperative analgesia was provided with buprenorphine via an epidural catheter. We noted intraoperative and postoperative complications.

RESULTS

Neuraxial blockade was satisfactory in all but four patients who required supplementation with general anesthesia for unduly prolonged surgery. There were no significant intraoperative hemodynamic changes. The total intravenous fluid used during surgery was 64.24 +/- 12.3 mL/kg. During the postoperative period, all patients had good postoperative pain relief with no incidence of epidural hematoma.

CONCLUSION

Combined spinal-epidural anesthesia proved to be a useful regional anesthetic technique, combining the reliability of spinal block and versatility of epidural block for renal transplantation.

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Authors+Show Affiliations

Bhosale G
Department of Anaesthesia and Critical Care, G.R. Doshi and K.M. Mehta Institute of Kidney Diseases and Research Centre, Dr H. L. Trivedi Institute of Transplantation Sciences, Gujarat, India. guruprasad.bhosale@gmail.com
Shah V
No affiliation info available

MeSH

AdultAnalgesicsAnesthesia, EpiduralAnesthesia, SpinalAnesthetics, LocalBlood PressureBradycardiaBupivacaineFemaleHumansHypotensionKidney TransplantationMaleMiddle AgedMonitoring, IntraoperativePostoperative Period

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18555130

Clinical Trial Links

Analgesic Effect of Three-point Transversus Abdominis Plane Block Compared With Continuous Epidural Infusion for Post-laparoscopic Nephrectomy
Quadratus Lumborum Block Versus Epidural for Laparoscopic Nephrectomy Kidney Donor

Citation

Bhosale, G, and V Shah. "Combined Spinal-epidural Anesthesia for Renal Transplantation." Transplantation Proceedings, vol. 40, no. 4, 2008, pp. 1122-4.
Bhosale G, Shah V. Combined spinal-epidural anesthesia for renal transplantation. Transplant Proc. 2008;40(4):1122-4.
Bhosale, G., & Shah, V. (2008). Combined spinal-epidural anesthesia for renal transplantation. Transplantation Proceedings, 40(4), 1122-4. https://doi.org/10.1016/j.transproceed.2008.03.027
Bhosale G, Shah V. Combined Spinal-epidural Anesthesia for Renal Transplantation. Transplant Proc. 2008;40(4):1122-4. PubMed PMID: 18555130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Combined spinal-epidural anesthesia for renal transplantation. AU - Bhosale,G, AU - Shah,V, PY - 2008/6/17/pubmed PY - 2008/8/8/medline PY - 2008/6/17/entrez SP - 1122 EP - 4 JF - Transplantation proceedings JO - Transplant Proc VL - 40 IS - 4 N2 - INTRODUCTION: A patient undergoing renal transplantation presents unique problems to the anesthetist, as almost every body system is affected. The combined spinal-epidural technique has become popular in lower abdominal surgeries because it offers the advantages of both spinal and epidural techniques. We review our experience of combined spinal-epidural technique in patients undergoing renal transplantation with respect to demographics, intraoperative anesthesia, hemodynamics, postoperative analgesia, and untoward adverse events. MATERIALS AND METHOD: Fifty consecutive patients scheduled for elective renal transplantation over a period of 4 months who consented for combined spinal-epidural anesthesia were enrolled in the study. Combined spinal-epidural anaesthesia was performed using a double-space technique in the right lateral position. Intraoperative monitoring included electrocardiography, pulse oximetry, noninvasive blood pressure, central venous pressure, and urinary output after clamp release. Intravenous fluids, colloids, and blood products were infused so as to keep the central venous pressure between 12 and 15 mm Hg. Postoperative analgesia was provided with buprenorphine via an epidural catheter. We noted intraoperative and postoperative complications. RESULTS: Neuraxial blockade was satisfactory in all but four patients who required supplementation with general anesthesia for unduly prolonged surgery. There were no significant intraoperative hemodynamic changes. The total intravenous fluid used during surgery was 64.24 +/- 12.3 mL/kg. During the postoperative period, all patients had good postoperative pain relief with no incidence of epidural hematoma. CONCLUSION: Combined spinal-epidural anesthesia proved to be a useful regional anesthetic technique, combining the reliability of spinal block and versatility of epidural block for renal transplantation. SN - 0041-1345 UR - https://www.unboundmedicine.com/medline/citation/18555130/Combined_spinal_epidural_anesthesia_for_renal_transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0041-1345(08)00231-5 DB - PRIME DP - Unbound Medicine ER -