Anaesthesia for kidney transplantation

Abstract

This paper describes the anaesthetic technique used for the first kidney transplant operation carried out in Sri Lanka. The patient was haemodialysed prior to surgery and his serum electrolytes were normal. A thorough clinical examination was carried out to exclude any foci of infection. Particular attention was given to getting all equipment ready and sterilized. The risk of introducing infection to the patient is high and since following transplant, the patient had to be on immunosuppressive drugs, all procedures were carried out under aseptic conditions wearing sterile gowns and gloves. Our technique consisted of inducing anaesthesia with thiopentone and intubation with suxamethonium and tubocurarine for neuromuscular block. Oxygen nitrous oxide and intermittent doses of pethidine were used for maintaining anaesthesia, with halothane to minimize blood pressure fluctuations. Following vascular anastomosis frusemide was given to promote a diuresis and hydrocortisone and Azathioprine to start immunosuppression. The patient was monitored meticulously during the entire operation with continuously ECG, CVP and frequent blood pressure recordings. At the end of surgery the neuromuscular block was reversed with atropine and neostigmine and the patient was sent to an Intensive care set up, breathing spontaneously.