ANESTHETIC MANAGEMENT IN PATIENTS WITH RENAL TRANSPLANT UNDERGOING CORONARY BYPASS GRAFT SURGERY

Abstract

Background- By the end of 2000, more than 10,000 patients had received renal transplants in the Islamic Republic of Iran (IRI), and this number is expected to increase yearly. Since the 1-year survival rate for renal transplant recipients is approaching 90% and is continuing to improve annually, an increasing number of patients who have received renal transplants present for coronary artery bypass graft (CABG) surgery. They represent a technically demanding group of patients who require special consideration regarding preserving renal graft function and minimizing possible complications of cardiac surgery. This study was conducted to evaluate the outcome in renal transplant patients undergoing CABG surgery. <br />Patients and Methods- We prospectively studied seventeen renal transplant patients with approximately normal preoperative renal function (plasma creatinine 1.1-1.5 mg/dL) scheduled for elective coronary artery bypass surgery. Various aspects of anesthesia and the surgical procedures were assessed as regards the function of the transplanted kidney.<br />Results- Renal blood flow and renal transplant function are influenced before the induction of anesthesia, after sternotomy and before cardiopulmonary bypass (CPB), during hypothermic CPB and normothermic CPB, after sternal closure, and postoperative bleeding. <br />Conclusion- Protective interventions are very important in renal transplant patients undergoing coronary artery bypass graft surgery to prevent deterioration of renal function. Hemofiltration was performed routinely to prevent volume overload and excessive hemodilution. We used low-dose dopamine infusion (renal dose) throughout the operation and phenylephrine infusion during cardiopulmonary bypass