ABSTRACT
AIM: To observe whether tight control of metabolic acidosis by infusion of 5% sodium bicarbonate can improve early post-operative renal function in living renal transplant recipients. METHODS: A total of 120 patients who underwent living donor renal transplant surgery in the First Affiliated Hospital of University of Science and Technology of China from March 2019 to March 2020, ASA Ⅲ-Ⅳ, were randomly divided into observation group and control group using random digits table. In observation group, 5% sodium bicarbonate was infused intra-operatively according to Base Excess (BE) measurements to achieve the normal values of BE (-3 to +3 mmol/L). In control group, infusion of 5% sodium bicarbonate was allowed only in case of severe metabolic acidosis (BE≤-10 mmol/L or pH≤7.25). Minute ventilation was adjusted to keep PaCO2 within the normal range. Hemodynamic parameters of two groups were recorded before anesthesia (T0), 10 minutes after induction of anesthesia (T1), before opening of renal artery (T2), 5 minutes after opening renal artery (T3) and the end of surgery (T4). The amount of bleeding, infusion fluid and operative time were recorded. Creatinine, urea nitrogen, urine outputs were recorded on days 1, 2, 3, 7, 30 after surgery. RESULTS: Compared with the control group, the amount of 5% sodium bicarbonate was significantly increased, the phenylephrine was decreased in the observation group (P<0.05), there was no indication of 5% sodium bicarbonate infusion in control group; the pH and BE in observation group were significantly higher than that in control group at the end of surgery (P<0.05). The MAP and CVP of both groups at T3 were lower than before anesthesia (P<0.05).The creatinine and urea nitrogen of observation group was lower than control group on days 1, 2, 3, 7 after surgery (P<0.05). The urine volume of observation group was higher than control group on days 1, 2, 3 after surgery(P<0.05). CONCLUSION: Intraoperative tight control of metabolic acidosis by infusion of 5% sodium bicarbonate in living renal transplant recipients may improve early post-operative renal function.
ABSTRACT
Objective To observe the hemodynamic change and stress reaction of target-con-trolled infusion (TCI)of propofol guided by Narcotrend for anesthetic induction in renal transplanta-tion patients.Methods Forty patients (25 males,1 5 females,aged 21-38 years,ASA grade Ⅲ orⅣ)undergoing related living donor kidney transplantation were randomly divided into two groups:group A and group B (n =20).Group A was induced using TCI system with propofol under the moni-toring of Narcotrend.Group B was induced with propofol manually.HR,MAP,Narcotrend index (NTI),blood glucose (Glu)and plasma cortisol (Cor)were measured before induction (T0 ),before tracheal intubation (T1 ),and 1 (T2 ),3 (T3 ),and 5 (T4 )minutes afterwards.Results HR and MAP at T1 were lower than those at T0 (P < 0.05 )in two groups,they were significantly lower in group B than in group A at corresponding points(P <0.05).HR and MAP in group B increased sig-nificantly (P <0.05)and were significantly higher than those in group A (P <0.05)at T2 and T3 . There was no obvious difference in Glu and Cor between T0 and T2-T4 in group A.Glu and Cor at T2-T4 were obviously higher than those at T0 (P <0.05)in group B and those at corresponding points in group A (P <0.05).Conclusion TCI of propofol guided by Narcotrend in renal transplantation pa-tients can better control the depth of anesthesia,attenuate the stress reaction caused by tracheal intu-bation,and keep hemodynamic smooth during anesthesia induction.