Changes of Serum Potassium During Renal Homotransplantation

Aldrete, J. Antonio; O'Higgins, J.W.; Starzl, Thomas E.

doi:10.1001/archsurg.1970.01340250084018

Cited by 5 publications

(1 citation statement)

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“…A recently conducted study 31 of 12 patients undergoing bilateral nephrectomy, splenectomy, and renal transplant in the same session showed that patients with high predialysis potassium levels (>6 mEq./L.) tended to develop hyperkalemia and electrocardiographic changes, even though the postdialysis potassium determinations had been within normal limits.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Anesthetic-Related Morbidity in Human Recipients of Renal Homografts

Aldrete¹,

Daniel²,

Jw³

et al. 1971

Anesthesia & Analgesia

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Kidney transplantation in humans has in the last decade changed from a promising clinical investigation to a practical reality. A common denominator in the preoperative condition of the recipient is terminal renal failure, which often is exacerbated by concomitant diseases. The consequent problems encountered during the anesthetic management of patients undergoing kidney homograft operations have been documented by many authors. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] The early reports 2,9,14 from our center were based on experience with the first 50 patients in our series. Since then, the total number of renal transplantations at the University of Colorado Medical Center has increased to 285. † In the present communication, the intraoperative management of 260 of these patients is described, as well as the anesthetic complications encountered. CLINICAL MATERIAL SexTwo hundred thirty-nine patients, of whom 80 (31 percent) were females and 180 (69 percent) males, received 260 kidneys. Eighteen patients had a second and 3 patients had a third transplant. Origin of KidneysThere were 254 homografts and 6 heterografts. Of the former, 2 were from identical twins, 221 from living donors (usually relatives), and 31 from cadaveric donors. Preoperative Physical StatusRecipient physical condition, evaluated at the time of transplant, showed no patients in A.S.A. class I, 20 in class II (7.7 percent), 150 in class III (57.7 percent), and 90 in class IV (34.6 percent). Most of the recipients were in the second, third, and fourth decades. The oldest was 57 and the youngest was 3 years of age (average 27.2 years). NIH Public Access Preanesthetic MedicationForty-four patients, all class IV, received no preanesthetic medication. The others received anticholinergic drugs, with or without narcotics, phenothiazines, and barbiturates. Duration of AnesthesiaThe longest surgical procedure lasted 780 minutes and the shortest was 150 (average 329 minutes). In slightly more than three-fourths of the cases, splenectomy and bilateral nephrectomy were performed at the same time as the renal transplant. For this reason, the period of anesthesia was not a reflection of the time required for homograft insertion. Anesthetic TechnicsA typical scheme of the anesthetic management of 1 of these patients is shown in figure 1. Anesthesia was intravenously induced by ultrashort-acting barbiturates in 197 patients and by inhalation in 25 cases. These 222 patients (85.4 percent) received inhalation anesthetic agents for maintenance. In addition, subarachnoid block with tetracaine and epinephrine was given to 14 recipients (5.4 percent), but had to be supplemented by inhalation agents either because of discomfort, lack of anesthesia, or protracted surgical procedures. For similar reasons, epidural blocks administered to 22 patients (8.4 percent) were unsatisfactory and general anesthesia was eventually administered to them. Only in one instance each were epidural (0.4 percent) and spinal (0.4 percent) blocks solely adequate for the whole operati...

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Section: Discussionmentioning

confidence: 99%