EFFICACY OF GENERAL EFFICACY OF GENERAL ANAESTHESIA WITH PROPOFOL-TCI ANAESTHESIA WITH PROPOFOL-TCI IN KIDNEY-TRANSPLANT PATIENTSIN KIDNEY-TRANSPLANT PATIENTS

Pham Van Dong M.D,PhD. Vu Thi Thu Huong, M.D.Nguyen Van Thanh, Bch.

• The eliminations of many drugs, especially the anesthetics are significantly reduced in end-Stage Renal Diseases.

• Sevoflurane, of which the metabolism has been implicated in renal toxicity, is still used to maintain anesthesia in previous studies.

INTRODUCTIONINTRODUCTION

INTRODUCTIONINTRODUCTION

• Propofol: fast induction, good maintenance of anaesthesia & safety, less effected by liver, kidney functions and not polluting the environment.

• Since 2011, TCI has been used at Cho Ray Hospital in anaesthesia: measuring exactly Cp & Ce more safe anaesthesia.

Purpose of study:

To evaluate:• The anesthetic effects of propofol-TCI during

the renal transplant-operations.• The influences on renal function after the

transplantation

SUBJECTS AND METHODS

• A prospective, descriptive study on 30 patients undergoing renal transplantations at Cho ray hospital from May 2012 to Jan 2014.

RESULTS & DISCUSSIONS • 30 patients totally, the majority is male: 22(73.3%)

and females: 8(26.7%).mean min max

EF(%) 62.4 ± 6.179 52 80

Weight(kg) 55.18 ± 9.35 38.5 76

Ages(year) 34.40 ± 11.773 17 62

Operation time(min)

270.17 ± 49.957 125 360

Anesthetic time(min)

306.67 ± 55.853 160 415

Ce mean

Mean Ce at each moment

• Start sleeping: 1.747µg/ml ± 0.293. • Intubation: 3.523µg/ml ± 0.529.• Maintained during the operation : 3.5 →

4.0µg/ml. • 15 minutes before completing surgery:

2.45µg/ml ± 0.597.• The skin closes : 1.237µg/ml ± 0.555.

Consumptions of dugs

Propofol/kg/h

Tracurium/kg/h

Fentanyl/kg/h

Sufentanil/kg/h

Mean 6.87 ± 1.198 0,37 ± 0.1 1.98 ± 0.55 0.349 ± 0.107

Min 5.05 0.23 0.90 0.17

Max 9.72 0.74 2.96 0.65

HEMODYNAMIC STATE

+ ESRD patients: normally with high blood pressure & difficult to manage. However, blood pressure is stable during surgery.

+ Intubation is the most influent technique+ open "renal artery clip”:

Systolics : 126.23 ± 12.99, MAP : 95.63 ± 11.654→ well renal perfusion.6 patients (20%) required Loxen, 2(6,67%) need Ephedrin to increase blood pressure after induction.

Total volume of NaCl 0,9% infused during operation: 3563.33 ± 565.980ml.

29/30 Patients (96.66%) had urine production immediate unclamping the kidney arterial. (prior data was 76.9% in Cho Ray hospital)

No patient was overload. 24/30 Patients (80%) were full recovery,

extubated 15 min after the end of operation (prior data: 96±84.76 minutes, CR hospital).

2 patients (6.66%) got shivering and 1 patient (3.33%) vomited in postoperative period.

• Propofol-TCI is safe, effective, and stable anesthesia for kidney transplantation with a rapid recovery, and early extubation. •Hemodynamic is stable during operation.•No influence on transplanted kidney function.

CONCLUSIONCONCLUSION