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  • Title: [Anesthetic management of pediatric renal transplantation: a review of 15 cases under the age of 10 years].
    Author: Yamamoto R, Nakai R, Nagasawa M, Terada T, Maehara Y, Sasaki J, Kikuchi H.
    Journal: Masui; 2003 Jun; 52(6):631-5. PubMed ID: 12854479.
    Abstract:
    BACKGROUND: In pediatric renal transplantation, an adult kidney is transplanted to a small child and it may cause severe cardiovascular insufficiency. METHODS: The anesthetic management of 15 pediatric recipients younger than 10 years, undergoing living-related renal transplantation were analyzed retrospectively. RESULTS: Before the operation, 3 of 15 patients were receiving hemodialysis, and the others were receiving peritoneal dialysis. Isoflurane was used for the anesthetic maintenance in most of cases. Arterial and central venous pressures were monitored invasively in all cases. Pulmonary arterial catheters and transesophageal echocardiography were used in some patients with cardiac complications. For intraoperative fluid management, a total volume of 18 ml.kg-1.h-1 (mean) was infused, which included approximately 8 ml.kg-1.h-1 of crystalloid, 7 ml.kg-1.h-1 of fresh frozen plasma, and 2 ml.kg-1.h-1 of washed red blood cells. Dopamine 1-7 micrograms.kg-1.min-1 and human atrial natriuretic peptide (hANP) 0.05-0.1 microgram.kg-1.min-1 were administered as diuretics. None of 15 patients developed severe cardiovascular insufficiency of poor diuresis. CONCLUSIONS: Cardiovascular stability and good function of the transplanted kidney were maintained by appropriate monitoring and continuous intravenous infusion of dopamine and hANP. It is important to infuse enough volume of fluid and blood before recanalization.
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