Anesthesia for pediatric renal transplantation with and without epidural analgesia – a review of 7 years experience

Coupe, Nicholas; O’Brien, Michelle L.; Gibson, Peter R.; Lima, Jonathan De

doi:10.1111/j.1460-9592.2005.01426.x

Cited by 43 publications

(31 citation statements)

References 32 publications

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“…Pediatric kidney transplant recipients receive large volumes of intravenous fluid in order to establish and maintain allograft perfusion . In addition to intraoperative crystalloid volumes approaching 200 mL/kg bodyweight, large volumes can be administered postoperatively to replace urine losses related to acute tubular injury.…”

Section: Introductionmentioning

confidence: 99%

Plasma electrolyte imbalance in pediatric kidney transplant recipients

Hayes

Longley

Scanlon

et al. 2019

Pediatric Transplantation

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Background In current practice, pediatric kidney transplant recipients receive large volumes of intravenous fluid intraoperatively to establish allograft perfusion, and further fluid to replace urinary and insensible losses postoperatively. Acute electrolyte imbalance can result, with potential for neurological sequelae. We aimed to determine the incidence and severity of postoperative plasma electrolyte imbalance in pediatric kidney transplant recipients managed with the current standard intravenous crystalloid regimen. Methods A retrospective analysis of plasma electrolytes in the first 72 hours post‐kidney transplant in 76 children transplanted between January 1, 2015, and January 31, 2018, managed with a standard intravenous fluid strategy used in most UK pediatric transplant centers. Results Of 76 pediatric transplant recipients of median age 9.9 (range 2.2‐17.9) years predominantly managed with 0.45% sodium chloride 5% glucose, 45 (59%) developed acute hyponatremia, 23 (30%) hyperkalemia, and 43 (57%) non‐anion‐gap acidosis in the postoperative period. Hyperglycemia occurred in 74 (97%) patients. Hyperkalemia was more prevalent in deceased than live donor recipients (P = 0.003) and was significantly associated with non‐anion‐gap acidosis (P < 0.001). Recipient weight was not associated with overt electrolyte imbalance. Conclusion Postoperative plasma electrolyte imbalance is common in pediatric kidney transplant recipients. Current clinical care strategies mitigate the associated risks of neurological sequelae to some degree. Further studies to optimize intravenous fluid therapy and minimize electrolyte disturbance in this group of patients are needed.

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Section: Introductionmentioning

confidence: 99%

Plasma electrolyte imbalance in pediatric kidney transplant recipients

Hayes

Longley

Scanlon

et al. 2019

Pediatric Transplantation

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“…The postoperative complication rate was significantly lower in the epidural group (5.5% vs. 20%, p<0.001) [19]. Postoperative epidural analgesia also improved the postoperative course following pediatric renal transplantation [20]. Among adolescents scheduled for scoliosis repair, a recent meta-analysis of all available studies (1966–2008) revealed that the administration of epidural local anesthetics plus intravenous opioids vs. intravenous opioids only was clearly associated with beneficial effects [21].…”

Section: Discussionmentioning

confidence: 99%

Epidural and opioid analgesia following the Nuss procedure

et al. 2011

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SummaryBackgroundParents have the right to decide on behalf of their children and deny consent to regional anaesthesia. The investigators decided to investigate quality of postoperative analgesia in adolescents undergoing epidural and opioid analgesia following the Nuss procedure.Material/MethodsThe study subjects were 61 adolescents aged 11–18 years who underwent pectus excavatum repair with the Nuss procedure. Patients were divided into epidural (n=41) and opioid (n=20) groups, depending on their parents’ consent to epidural catheter insertion. Intraoperatively, 0.5% epidural ropivacaine with fentanyl or intermittent intravenous injections of fentanyl were used. Postoperative analgesia was achieved with either epidural infusion of 0.1% ropivacaine with fentanyl, or subcutaneous morphine via an intraoperatively inserted “butterfly” cannula. Additionally, both groups received metamizol and paracetamol. Primary outcome variables were postoperative pain scores (Numeric Rating Scale and Prince Henry Hospital Pain Score). Secondary outcome variables included hemodynamic parameters, additional analgesia and side effects.ResultsHeart rate and blood pressure values in the postoperative period were significantly higher in the opioid group. Pain scores requiring intervention were noted almost exclusively in the opioid group.ConclusionsDenial of parental consent to epidural analgesia following the Nuss procedure results in significantly worse control of postoperative pain. Our data may be useful when discussing with parents the available anaesthetic techniques for exceptionally painful procedures.

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“…In 20 patients, patient controlled intravenous analgesia also had to be supplemented with systemic administration of opioids when the quality of the analgesia was inadequate [35]. There have been only a few studies so far on the potential risk of complications in patients who have undergone transplantation with PDA.…”

Section: Immunosuppression Following Organ Transplantationmentioning

confidence: 99%

Regional anesthetic procedures in immunosuppressed patients

Gronwald

Vowinkel

Hahnenkamp

2011

Current Opinion in Anaesthesiology

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So far, there are no guidelines available dealing with indications and limitations of regional anesthetic procedures in these patients. The complication rate is rare but potentially disastrous. However, the technique itself cannot be regarded as absolute contraindication for immunosuppressed patients if precautions are taken. An interdisciplinary approach regarding the indication of regional anesthesia techniques in immunosuppressed patients is recommended. Efforts must therefore be made to achieve an interdisciplinary consensus with relevant risk-benefit considerations.

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Anesthesia for pediatric renal transplantation with and without epidural analgesia – a review of 7 years experience

Cited by 43 publications

References 32 publications

Plasma electrolyte imbalance in pediatric kidney transplant recipients

Plasma electrolyte imbalance in pediatric kidney transplant recipients

Epidural and opioid analgesia following the Nuss procedure

Regional anesthetic procedures in immunosuppressed patients

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