Combined epidural and general anesthesia for paediatric renal transplantation-a single center experience.
BACKGROUND
Appropriate anesthesia for pediatric renal transplantation requires stable intraoperative hemodynamics, optimal perfusion of the newly transplanted kidney and good analgesia during recovery. The aim of this study was to assess the preliminary application, success and safety of combined epidural and general anesthesia in pediatric renal transplantation in a small cohort.


METHODS
We retrospectively reviewed the anesthesia records of 46 consecutive pediatric patients who received renal transplantation under combined epidural and general anesthesia from January 2003-2007.


RESULTS
The mean patient age and weight were 13.2 +/- 2.4 years and 25.7 +/- 5.46 kg, respectively. The infused crystalloids, 20% albumin and red blood cell concentrates were 120 +/- 2 mL/kg to achieve a CVP of 13 to 15 mm Hg. Brisk diuresis was observed in all patients. Epidural tramadol (2 mg/kg) provided good postoperative analgesia in 89% patients. 15% patients developed radiological evidence of pulmonary edema, only one required mechanical ventilation for hypoxemia. Minor adverse effects were nausea and vomiting (17.5%) and convulsions (8.5%). No perioperative mortality or major morbidity was recorded.


CONCLUSIONS
Epidural anesthesia is a useful adjunct to general anesthesia due to stable intraoperative haemodynamics and good postoperative analgesia.
Shah
V R
VR
Department of Anesthesia, Institute of Kidney Diseases and Research Center and Institute of Transplantation, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India. drveenarshah@gmail.com
Butala
B P
BP
Parikh
G P
GP
Vora
K S
KS
Parikh
B K
BK
Modi
M P
MP
Bhosale
G P
GP
Mehta
T
T
D000293:Adolescent; D000700:Analgesics / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D014839:Vomiting / Q000517:prevention & control
D000700:Analgesics; D008775:Methylprednisolone