Methemoglobin levels during epidural anesthesia for renal transplantation-Comparison of prilocaine with bupivacaine

One goal of anesthesia for renal transplantation is to avoid an excess load to be imposed on the newly functioning kidney, by using appropriate agents and dosages in the perioperative management. The purpose of this study was to investigate the effect of prilocaine on serum methemoglobin levels when used as the local anesthetic in epidural anesthesia for renal transplantation, and to compare its effects with that of bupivacaine, which is the standard local anesthetic used. 26 adult renal recipients were randomized into 2 equal groups according to the local anesthetic used for epidural anesthesia during the operation. Patients in group P [n = 13] were given prilocaine and those in group B [control, n = 13] received bupivacaine. The methemoglobin measurement intervals were at: baseline before administration of local anesthetic, and then at 2 hours, 5 hours, and 12 hours of local anesthetic administration. Methemoglobin levels in the prilocaine group were above the normal range in all measurements other than baseline. In the bupivacaine group, methemoglobin levels increased only at 5 hours of local anesthetic administration. However, methemoglobin concentrations and hemoglobin levels were comparable between the two groups at all time intervals, and none of the patients demonstrated clinical symptoms. The use of prilocaine in epidural anesthesia for renal transplantation surgery resulted in an increase in methemoglobin levels, which did not cause any clinical symptoms and was similar to those of bupivacaine at all time measurements

Fluid resuscitation of acute hemorrhage in uninephrectomized rabbits: effects on the early function of the remnant kidney

The aim of this study was to determine the effects of fluid resuscitation of acute hemorrhage on the early function and histopathology of the remnant kidney in uninephrectomized rabbits. Thirty-nine adult rabbits were studied in four groups. Group I [n = 8] included healthy controls; Group 2 [n = 10] healthy, bled animals; Group 3 [n = 10] uninephrectomized, non-bled animals; and Group 4 [n = 11] uninephrectomized, bled animals. In the hemorrhage groups, 8 mL kg[-1] of blood was drawn, and replaced with lactated Ringer's solution three times the volume of shed blood. Urine and blood samples were collected after 120-minutes of observation. None of the animals experienced hypotension during the study period. Serum and urinary electrolytes were similar between the Groups [p > 0.05]. Urine output was lower in Groups 3 and 4 than in Group 1 [p=0.001, both]. Urinary microalbumin, NAG, fractional sodium excretion and creatinine clearance were similar in all four Groups. Light microscopic evaluation revealed only slight enlargement of the proximal tubule lumen in the renal medulla of the rabbits that were both uninephrectomized and bled. We observed no deleterious effects of well resuscitated hemorrhage on early function and histopathology of the remnant kidney in uninephrectomized rabbits