title: Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study.
abstract: OBJECTIVE
  Antihypertensive drugs are continued until the day of renal transplant surgery. These are associated with increased incidence of hypotension and bradycardia. Hence, this study was designed to evaluate perioperative haemodynamic and early graft functioning in renal recipients with discontinuation of antihypertensive drugs on the morning of surgery.
  
  
  METHODS
  This prospective, randomised, double-blind study recruited 120 patients. Group 1 patients received placebo tablet while Group 2 patients received usual antihypertensive drugs on the day of surgery. Perioperative haemodynamics and time for reinstitution of antihypertensives were the primary outcome measures. The secondary outcome measures were need for inotropic support and graft function. Perioperative haemodynamics were analysed using ANOVA and Student'st-tests with Bonferroni correction. Fischer's exact test was used for analysis.
  
  
  RESULTS
  Systolic blood pressure (SBP) declined, which was more in Group 2. Forty-one patients developed significant hypotension; a correlation was found between the maximum observed hypotension and number of antihypertensive medications (P= 0.003). Four cases had slow graft function (one in Group 1 and three in Group 2). Twenty-eight patients in Group 2 required mephentermine boluses to maintain their SBP compared to 13 patients in Group 1 (P< 0.001). Two patients in Group 2 required dopamine to maintain SBP above 90 mmHg after the establishment of reperfusion as compared to none in Group 1.
  
  
  CONCLUSIONS
  Single dose of long-acting antihypertensive drugs can be omitted on the morning of surgery without any haemodynamic fluctuations and graft function in controlled hypertensive end-stage renal disease renal transplant patients receiving a combined epidural and general anaesthesia.
authors.affiliation: Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India.
authors.forename: Vinod
authors.initials: V
authors.lastname: Kumar
authors.affiliation: Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Virendra Kumar
authors.initials: VK
authors.lastname: Arya
authors.affiliation: Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Rakesh V
authors.initials: RV
authors.lastname: Sondekoppam
authors.affiliation: Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Arora
authors.affiliation: Professor and Head, Transplant Surgery Unit, PGIMER, Chandigarh, India.
authors.forename: Mukut
authors.initials: M
authors.lastname: Minz
authors.affiliation: Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Garg
authors.affiliation: Department of Onco-Anaesthesia and Palliative Medicine, AIIMS, New Delhi, India.
authors.forename: Nishkarsh
authors.initials: N
authors.lastname: Gupta
keywords: Antihypertensive therapy; graft function; haemodynamic; perioperative; renal transplant