Recent Less-invasive Circulatory Monitoring during Renal Transplantation

Abstract

For anesthetic management during renal transplantation, it is necessary to maintain the blood flow and function of the transplanted kidney by performing massive fluid management and stabilizing blood pressure. We report anesthetic management for renal transplantation with a less-invasive circulatory monitoring system (Edwards Life Sciences Co., Ltd., Irvine, California, U.S.A.). In November 2010, renal transplantation was started in our hospital, and performed in 6 patients. In the first patient, fluid/circulatory management was conducted by connecting a standard arterial line and a standard central venous (CV) line. In the second patient, a FloTrac(TM) system and a standard CV line were used. In the third patient, a standard arterial line and a PreSep(TM) CV Oximetry Catheter were used. In the fourth and fifth patients, a FloTrac(TM) and a PreSep(TM) were used. In the latest patient, FloTrac(TM) and PreSep(TM) were connected to an EV1000(TM) Clinical Platform for fluid/circulatory management. The establishment of high-visibility monitors was useful for evaluating the condition and confirming the effects. As there are marked changes in hemodynamics, the CV pressure, which has been used as a parameter of fluid management, is not reliable in renal failure patients with a high incidence of cardiovascular complications. Advances in noninvasive circulatory monitoring with dynamic indices may improve the safety of anesthetic management during renal transplantation.

Comparison of the Effects of Target-Controlled Infusion of Propofol and Sevoflurane as Maintenance of Anesthesia on Hemodynamic Profile in Kidney Transplantation

“…There were no significant differences in delayed graft function, dialysis after kidney transplant failure, and posttransplant infection between groups although nonsignificant higher mortality was seen in the TCI propofol group. Intraoperative hemodynamic stability is essential to maintain organ perfusion, while anesthetic conditioning such as sevoflurane and propofol has a protective effect to attenuate IRI and prevent delayed graft function [5, 8, 11]. However, our study sample was not designed to have enough power for detecting postoperative complications and outcome.…”

“…Hemodynamic parameters including cardiac output (CO), stroke volume (SV), and systemic vascular resistance (SVR), or which indexes according to body surface area (BSA) and mean arterial pressure (MAP) are continually recorded through a semi-invasive monitor during and after surgery. Intraoperative monitoring and using an appropriate anesthetic regimen that assures hemodynamic stability in kidney transplantation are important to prevent delayed graft function of the new kidney and decrease the risk of postoperative dialysis [5, 8, 11]. The use of drugs with low metabolism, short half-life, and extrarenal clearance should be the choice to allow a rapid emergence with early cognitive and psychomotor function recovery [12].…”

Intraoperative Fluid Management in Combined Liver-Kidney Transplantation

“…[16,17] The CVP is being replaced with the new hemodynamic parameter, such as stroke volume variation (SVV), which may be used as a surrogate to measure shifts in position of the Frank-Starling curve, for optimal fluid management in the patients receiving mechanical ventilation. Despite the superiority of SVV to CVP, the promising results of its use in the patients undergoing LT or KT are emerging [18,19] and there are no studies reporting the usefulness of SVV in CKLT at this point. However, some previous studies have reported CVP-targeting fluid management for LT or KT.…”

Effectiveness of using non‐invasive continuous arterial pressure monitoring with ClearSight in hemodynamic monitoring during living renal transplantation in a recipient:a case report

“…We managed the fluid volume with SVV obtained with the ClearSight to predict fluid responsiveness. Stroke volume variation may be a useful parameter to predict hypovolemia and fluid responsiveness during renal transplantation (3).…”

“…Not only finger-cuff-based monitoring of blood pressure (FBP), but the ClearSight system provide heart rate (HR), stroke volume (SV), cardiac output (CO), cardiac index (CI), stroke volume index (SVI), stroke volume variation (SVV), systemic vascular resistance (SVR), and systemic vascular resistance index (SVRI) (3). It is noninvasive measurement.…”