Combined spinal-epidural anesthesia for renal transplantation.
BACKGROUND
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.


METHODS
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.


CONCLUSIONS
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.
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
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Bhosale
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Shah
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use; D001794:Blood Pressure; D001919:Bradycardia / Q000517:prevention & control; D002045:Bupivacaine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000517:prevention & control; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D011184:Postoperative Period
D000700:Analgesics; D000779:Anesthetics, Local; D002045:Bupivacaine