title: Low-dose Spinal Block With Continuous Epidural Infusion for Renal Transplantation in a Patient With Alport Syndrome: A Case Report.
abstract: OBJECTIVE
  We aim to describe management of a patient receiving renal transplantation for chronic renal failure due to Alport syndrome with low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic.
  
  
  METHODS
  A 38-years-old man with chronic renal failure secondary to Alport syndrome underwent kidney transplantation. Because of a high risk of respiratory and cardiovascular complications related to the patient's baseline lung disease and abnormalities in heart conduction, we selected combined spinal-epidural anesthesia. The block was ultrasound-guided and performed at the T12-L1 interspace with 4.5 mg of 0.5% intrathecal hyperbaric bupivacaine followed by a continuous epidural infusion of 0.5% levobupivacaine mixed with 25 μg of Fentanyl at the initial rate of 8 mL/h. Sensory block to T5-T6 was obtained within 10 minutes. The patient then received mild sedation with Propofol and Remifentanil. Methylprednisolone and diuretics were administered before vascular unclamping according to our internal protocol. Surgery lasted 3 hours with no clinical or procedural complication.
  
  
  CONCLUSIONS
  Although renal transplantation is usually performed under general anesthesia, in a particularly complex patient with chronic renal failure, chronic obstructive pulmonary disease and a worsened respiratory mechanics, we applied a combined approach with a low dose of intrathecal bupivacaine and continuous epidural infusion of local anesthetic. The technique did not affect hemodynamics while having a positive impact on recovery of function of the transplanted organ with rapid improvement of urine output, serum creatinine, and blood urea nitrogen levels.
authors.affiliation: Department of Anesthesia and Intensive Care, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Gobbi
authors.affiliation: Department of Surgical Sciences, University of Turin, Turin, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Sales
authors.affiliation: Department of Thoracic-Vascular Surgery, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bretto
authors.affiliation: Department of Anesthesia and Intensive Care, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: P P
authors.initials: PP
authors.lastname: Donadio
authors.affiliation: Department of Anesthesia and Intensive Care, Città della Salute e della Scienza Hospital, Turin, Italy; Department of Surgical Sciences, University of Turin, Turin, Italy. Electronic address: luca.brazzi@unito.it.
authors.forename: L
authors.initials: L
authors.lastname: Brazzi
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General; D000775:Anesthesia, Spinal / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage* / Q000031:analogs & derivatives; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D000077554:Levobupivacaine; D008297:Male; D009394:Nephritis, Hereditary / Q000150:complications / Q000601:surgery*; D015742:Propofol / Q000008:administration & dosage; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol