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腎臟移植患者의 麻醉 24例

Anesthesia for Renal Transplantation-Report of 24 Castes-

대한마취과학회지 1977년 10권 1호 p.43 ~ 53
유승아, 이상묵, 김주환, 류재덕, 박종훈, 강종후,
소속 상세정보
유승아 (  ) - 가톨릭대학교 의과대학 마취과학교실
이상묵 (  ) - 가톨릭대학교 의과대학 마취과학교실
김주환 (  ) - 가톨릭대학교 의과대학 마취과학교실
류재덕 (  ) - 가톨릭대학교 의과대학 마취과학교실
박종훈 (  ) - 가톨릭대학교 의과대학 마취과학교실
강종후 (  ) - 가톨릭대학교 의과대학 마취과학교실

Abstract


This is a report of anesthesia bone for 24 cases of renal transplantation performed at St. Mary´s Hospital, Catholic Medical college, Seoul, Korea, between 25 March 1969 and 19 August 1976.
The recipient of renal transplantation show many critical conditions which require special considerations in performing anesthesia. The patient´s preoperative condition sholuld be evaluated more carefully than most other kinds of furgical patients and anesthesia technic also must be selected specially.
All kidney grafts were obtained from living donors. The family linkage of 24 donors was: 7 cases(29.1%) were from parents, 3 cases(12.5%) from children, 9 cases (37.5%) from siblings, 3 cases(12.5%) from other relatives and 2 cases (8.3%) were from nonrelated persons. In the sex distribution of the donos, each sex was equally distributed. All donors were anesthetized by means of endotracheal anesthesia using halothane, nitrous oxide and oxygen. As to complications during the nephrectomy of donors, a case of hiccup and two cases of pleural tear were encountered. The removed kidney was perfused with Hartmann´s solution before transplantation and the choice of anesthetic agents caused no problems in the function of transplanted kidneys.
The recipients had histories of chronic glomerulonephritis or pyelonephritis from 6 months to 32 years and showed uremic conditions. Their mean age was 38 years, ranging from 18 years to 59 years. The most frequent age group of the recipients was the 30 and 40 year group. Most recipients were males; among 24 cases, only 3 were females. Most of the recipients had decreased function of heart and lungs, severe anemia difficult to correct by blood transfusion(Hb. 7.3gm%, Hct. 24.2%), increased BUN(70.36±31.34㎎/dl), hyperkalemia (4.67±0.63mEq/L), poor and fragile veins, bleeding tendency and decreased kidney function(serum creatinine 10.48 edmea, ±2.99㎎/dl). Prolonged medication to the recipient was another hazard to anesthesia. To lessen the risk during the anesthesia maintenance, preoperative preperation of the recipient was done by hemodialysis or peritoneal dialysis.
Premedication of the recipients was performed by valium(5∼15㎎) and atropine(0.4∼0.5㎎) one hour before anesthesia. For the anesthetic technic, endotracheal anesthesia was applied to all cases. Induction was done with intravenous pentothal sodium, 150∼250㎎ or Epontol 250∼500㎎. As to the muscle relaxant to facilitate intubation, succinylchline for 11 cases of the initial period of the transplantation, later gallamine for one case and pancuronium for the recent 12 cases. All anesthesia was maintained with halothane, nitrous oxide and oxygen. Muscle relaxants were used in all cases during the surgery: succinylcohline drip for the initial 7 cases, d-Tubocurarine for 2 cases, gellamine for 2 cases and pancuronium for the recent 12 cases. Galllamine seems to be not contraindicated, as far as the active diuresis could be anticipated after the transpantation. Amount of blood transfused during operation was 2,041 ml in average, ranging from 800 ml to 5000 ml and fluid infused was 1,242 ml of Hartmann´s sol. and/or other solutions. Respiration was controlled manually or mechanically. During the anesthesia, 16 cases of hypertension, 7 cases of arterial hypotension, 3 cases of arrhythmia, one case of tight chest and one case of tachycardia, were encountered. Emergence of anesthesia was within 15 miuntes.
After the transplantation, diuresis started in 33 minutes on the average and most patients showed marked diuresis in which urine volume of 24 hours was 10,164 ml on the average. The total surgical procedure lasted 4 hours and 50 minutes on the average, ranging from 3 hours 50 minutes to 7 hours. The ischemic time of the removed kidney was 32 minutes in average.
Followup of the patients showed that 10 cases died out of 24 cases between 4 months and 4 years.after the surgery Patients surviving more than 1 year were 11 cases out of 15 cases(73.3%), two cases cut of 8 cases(25%) survived more than 2 years and two cases out of 8 cases(25%) more than 3 years. One case had the longest survival of 7 1/3 years.

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