Moderate hydration and dopamine infusion during anaesthesia for renal transplantation: does it matter with the incidence of postoperative ANT

This study was conducted on 20 kidney recipient randomly classified into 2 groups, dopamine infusion was given to the second group [n = 10] to evaluate the effect of moderate hydration with or without dopamine on the incidence of ATN. Heart rate, mean blood pressure, central venous pressure, urine output and creatinine were recorded perioperatively. The results of this study showed that there is no significant difference between the 2 groups on the incidence of ATN. It was concluded that moderate hydration without dopamine decrease the incidence of ATN after renal transplantation

Respiratory mechanics during laparoscopic nephrectomy

37 adult ASA I or II patients divided into 3 groups and subjected to laparoscopic nephrectomy were assigned for this study. Oral diazepam was used for premedication. Induction with thiopentone sodium, suxamethonium sequence and maintenance of anesthesia were achieved differently in each group. In group 1, it was N2O: O2 halothane 0.5- 1%, while in group 2 N2O: O2 morphine were used. In group 3, lumber epidural analgesia [using bupivacain 0.8 mg/kg + 2 mg morphine] preceded general anesthesia, N2O: O2 was used for maintenance. Pancuronium was the non-depolarizing muscle relaxant used. Intraperitoneal CO2 insufflation was performed in lateral decubitus position. Respiratory mechanics including total chest compliance, peak inspiratory pressure, respiratory and expiratory resistance were recorded for every patient, before and after maximal CO2 insufflation and after deflation of CO2. Significant decrease in total chest compliance and significant increase in both peak inspiratory pressure and expiratory resistance were recorded with maximal CO2 insufflation. This was recorded in all groups studied irrespective to the mode of balanced anesthesia used. CO2 pneumoperitoneum during laparoscopic nephrectomy adds to the ventilatory impairment induced by anesthesia and lateral decubitus position which mandate careful adjustment of patient ventilation during the procedure

Noninvasive monitoring during laparoscopic nephrectomy

Thirty seven adult patients divided into 3 groups undergoing laparoscopic nephrectomy were used for this study. They were premedicated with oral diazepam. Thiopentone sodium, suxamethonium were used for induction of anesthesia and endotracheal intubation. Maintenance of anesthesia was with N2O: O2 halothane in group 1 and N2O: O2 morphine in group 2. In group 3, epidural analgesia using bupivacaine [0.8 mg/kg] and morphine [2 mg] preceded general anesthesia that was maintained with N2O: 02. Pancuronium was the muscle relaxant used to control ventilation. Intraperitoneal CO2 insufflation was performed in lateral decubitus position. Monitoring of pulse, systolic and diastolic blood pressure,% oxygen saturation either arterial or by pulse oxymetry and CO2 in arterial blood [PaCO2] and expired air [PETCO2], was done during the whole procedure. No sharp swings were recorded by monitoring pulse and blood pressure. Satisfactory% O2 saturation was maintained as detected by both methods of monitoring during the operation. Significant increase in both PaCO2 and PETCO2 was seen after CO2 insufflation. Both methods of monitoring CO2 run together with no significant difference between them in all groups studied. Noninvasive monitoring may be satisfactory for the majority of patients, while invasive cardiovascular and blood gas monitoring may be necessary for compromised patients

Arterial gasometry during laparoscopic nephrectomy

Thirty seven adult patients undergoing laparoscopic nephrectomy were chosen for this study. They were divided into three groups. Premedication was with oral diazepam. Thiopentone-suxamethonium were used for induction of anesthesia and endotracheal intubation. Maintenance of anesthesia was by N2O: O2 halothan 0.5-1% in group 1 and N2O: O2 morphine in group 2. In group 3 epidural analgesia using bupivacaine and morphine preceded general anesthesia which was maintained by N2O: O2. Muscle relaxation was achieved by pancuronium. Intraperitoneal insufflation of CO2 was performed in lateral decubitus position. Arterial blood samples were collected during the operation for determination of PaO2, PaCO2, SO2, pH and PAO2. Maintenance of significantly high PaO2, SO2, PAO2 and P[A-a]O2 over the basal level was achieved after increasing inspired O2 concentration from 21% to 35%. Significant increase in PaCO2 and P50 and significant decrease in pH extending to the postoperative period, were observed due to storage of excess CO2 in body tissue during the prolonged procedure. Arterial blood gas monitoring may be required to detect developing hypercarbia and acidosis during laparoscopic nephrectomy