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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