Combined spinal-epidural anesthesia for renal transplant in a lung transplant recipient: a case report
Main Article Content
Keywords
Renal Transplant, Combined Spinal-Epidural Anesthesia, lung transplant, perioperative medicine
Abstract
A 67-year-old lung transplant recipient with severe comorbidities was admitted for renal transplant. As anesthesia technique, combined spinal-epidural at the T11-T12 level was chosen, associated with intravenous sedation. Graft’s function initially results altered, bringing to pulmonary fluid overload. Beginning from the postoperative day 5 there was a slow but constant gain-of-function of the graft, proven by an improvement of renal function indexes and by the resolution of the pulmonary edema.
Conclusions: Whereas general anesthesia remains the gold standard anesthesia technique for kidney transplant, a locoregional anesthesia, could be a feasible and effective option in patients at high risk of respiratory complications. (www.actabiomedica.it)
Downloads
References
2. Feltracco P, Falasco G, Barbieri S, Milevoj M, Serra E, Ori C. Anesthetic considerations for nontransplant procedures in lung transplant patients. J Clin Anesth. 2011;23(6):508-516. doi: 10.1016/j.jclinane.2011.05.002.
3. Royer PJ, Olivera-Botello G, Koutsokera A, et al. Chronic Lung Allograft Dysfunction: A Systematic Review of Mechanisms. Transplantation. 2016 Sep; 100(9):1803-1814. doi: 10.1097/TP.0000000000001215.
4. Massoudi N, Safari F, Mottaghi K. Spinal Anesthesia for Renal Transplantation in Lung Resected Patient: A Case Report. Tanaffos. 2018, Mar; 17(3):207-210.
5. Ricaurte L, Vargas J, Lozano E, Díaz L; Organ Transplant Group. Anesthesia and kidney transplantation. Transplant Proc. 2013 May;45(4):1386-91. doi: 10.1016/j.transproceed.2012.12.014.
6. Bhosale G, Shah V. Combined Spinal-Epidural Anesthesia for Renal Transplantation. Transplant Proc. 2008; 40(4):1122-1124. doi: 10.1016/j.transproceed.2008.03.027.
7. Hadimioglu N, Ertug Z, Bigat Z, Yilmaz M, Yegin A. A randomized study comparing combined spinal epidural or general anesthesia for renal transplant surgery. Transplant Proc. 2005 Jun;37(5):2020-2. doi: 10.1016/j.transproceed.2005.03.034.
8. Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol. 2008;74(10):549-563.
9. Amir-Zargar MA, Gholyaf M, Kashkouli AI, Moradi A, Torabian S. Comparison of safety and efficacy of general and spinal anesthesia in kidney transplantation: Evaluation of the peri-operative outcome. Saudi J Kidney Dis Transpl. 2015;26(3):447-452. doi: 10.4103/1319-2442.157300.
10. Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020 Jun 3;13:39-46. doi: 10.2147/LRA.S240753.
11. Wuethrich PY, Burkhard FC, Thalmann GN, Stueber F, Studer UE. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology. 2014 Feb;120(2):365-77. doi: 10.1097/ALN.0b013e3182a44440.
12. Lemmens HJM. Anesthesia for kidney transplantation. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed 4, 2021.
13. Sanghani NS, Soundararajan R, Golper TA. Medical management of the dialysis patient undergoing surgery. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed 4, 2021.
14. Monsalve C, Izquierdo L, Alcaraz A. Interactions Between Hemodynamics and Pharmacology in Kidney Transplantation. Transplant Proc. 2011; 43(1):359-362. doi: 10.1016/j.transproceed.2010.12.018.
15. Ma GG, Tu GW, Zheng JL, et al. Changes in Stroke Volume Variation Induced by Passive Leg Raising to Predict Fluid Responsiveness in Cardiac Surgical Patients With Protective Ventilation. J Cardiothorac Vasc Anesth. 2020;34(6):1526-1533. doi: 10.1053/j.jvca.2019.10.002.
