SlideShare a Scribd company logo
1 of 51
Download to read offline
READ BY : EKO INDRA PRADONO
SUPERVISOR : Dr. HASANUL, SpAn, KAP, KIC.
INTRODUCTION
• Kidney transplantation is a process of attaching new
kidneys to replace previously diseased kidneys.
• The incidence of end stage renal disease (ESRD) has
increased over the past several decades due to an
increased incidence of diabetes, obesity and
hypertension
• Survival and health related quality of life is better
after kidney transplantation than after dialysis
therapy.
• Improvement in immunosuppression regimens which
have reduced rates of acute transplant rejection
HISTORY OF KIDNEY TRANSPLANT
• In 1933, first human renal allograft was performed
by Voronoy in the Ukraine.
• The recipient was 26 y.o. woman who attempted
suicide by ingesting mercury chloride, the donor
was 66 y.o man whose kidney was removed 6
hours after death. Patient was death 48 hours
after surgery.
In 1933, first human
renal allograft was
performed by Voronoy
in the Ukraine.
In 1995  First
laparoscopic donor
nephrectomy was
done.
In 1977, The first
kidney transplant
surgery in Indonesia
was performed by
Prof. dr. R.P. Sidabutar
and team at Cipto
Mangunkusumo
Hospital, Jakarta
In 2011  First
Laparoscopy living
donor
nephrectomy
(LLDN) was
performed at Cipto
Mangunkusumo
Hospital, Jakarta
Until 2015  there
were over than 200
Laparoscopic Living
Donor Nephrectom
(LLDN) performed in
RSCM.
• From 200 cases, 133 donor (66.5%) Man and 67
(33.5%) Women
• The Average age 32,75 YO with SD ±9,45
• 165 LLDN (82,5%) performed in left kidney and 35
procedure (17,5%) performed in right kidney
Kidney Transplant Center in Indonesia
– RSCM Jakarta: 3 times / week
– Cikini Hospital
– Surabaya
– RSPAD Gatot Subroto
– Bandung
– Yogyakarta
– Malang
– Medan ?
Kidney Transplant in Indonesia
Initiated in 1977
Data for RSCM and Cikini CCI is updated for mid 2012
Data for remaining hospitals is updated for 2010
Courtesy of Situmorang GR, Wahyudi I, Siahaan E, et al
Survival Analysis
Courtesy of Situmorang GR, Wahyudi I, Siahaan E, et al
RIGHT VS LEFT LLDN
A single-centre RCT
revealed no differences
between left- and
right-sided donor
nephrectomy in donor
hospital stay, donor
quality of life, donor
and acceptor
complication rates, or
graft survival
Parameters Left LLDN
(n=82)
Right LLDN
(n=18)
P value
Operating time (min) 262.9 ± 50.0 253.1 ± 42.0 0.44*
Blood loss (ml) 269.9 ± 52.4 230.6 ± 49.1 0.55*
Length of hospital stay
(days)
4.6± 1.4 4.5 ± 1.4 0.86*
Warm ischemic time (min) 6.2 ± 3.4 5.7 ± 2.5 0.60*
LLDN in Cipto Mangunkusumo Hospital
(Nov 2011 – Now)
The Technique
Renal transplantation surgery includes :
A. Retrieval of kidney from live/deceased
donor-Donor nephrectomy
Live/Cadaveric
B. Placement of donor kidney into the
recipient’s body  renal
transplantation
The kidney removal from a prospective
live kidney donor is either by an open
approach or by a laparoscopic approach.
Living Donor Nephrectomy
• accepted by law, religion and bioethics, provided that the
donor is aware of the consequences of his/her act and
makes the decision without outside prenure or
commercialism.
• Once the prospective donor is medically fit for donation, the
last step is surgical evaluation  assessment of the
anatomic features of the donor kidney  nephrectomy can
safely be performed?
CT Angiografi
POSITION
Modified lateral decubitus position with hips rotated back and arm extended above
the head. The table is flexed to expand the area between the costal margin and
pelvic brim.
LLDN
LLDN
RECIPIENT SURGERY
• The general preparation and selection of recipient
commences with the nephrological evaluation and
ends with evaluation by the transplant surgeon.
• After induction of anesthesia and placement of
central and arterial lines, the recipient is prepared and
draped from nipple to mid thigh.
• A third generation cephalosporin is given at time of
induction.
• A three way urinary catheter is placed with full aseptic
precautions and unobstructed drainage is ensured.
PRE-OPERATIVE CONSIDERATIONS
MULTISYSTEM DYSFUNCTION
1. Cardiovascular
Hypertension, ischemic heart disease, cardiac failure,
pericarditis
2. Respiratory
Pulmonary edema, pleural effusion, respiratory infection
3. Gastrointestinal
Stress ulceration, delayed gastric emptying, malnutrition
4. Central nervous
Peripheral neuropathy, autonomic neuropathy, mental slowing,
convulsions, coma
5. Renal
Fluid and electrolyte imbalance, altered pharmacokinetics and
pharmacodynamics
6. Hematological
Anemia, coagulopathies
7. Immunological Immunosuppression
8. Dialysis related problems
a. Peritonitis (peritoneal dialysis)
b. Systemic anticoagulation
c. Vascular access
d. Dementia
MULTISYSTEM DYSFUNCTION (2)
Anesthetic considerations for kidney transplant in an adult
Anesthetic considerations for kidney transplant in an adult
TIMELINE OF RECIPIENT KIDNEY TRANSPLANT
Expected length of stay 5 days
Preparation at
outpatient clinic
for laboratory test
and imaging
H-1 days  Donor is
hospitalized.
Consultation to others
department
Preparation of surgery
equipment, Blood preparation
300 cc of PRC
Day of
Surgery
H+1  aff drain if
production < 50 ml,
aff epidural
catheter
H+2 aff
urethral catheter
1st week after
surgery  follow up
at outpatient clinic,
aff hecting
1st year after surgery
 follow up at
outpatient clinic,
evaluation general
condition and kidney
function
PATIENT SELECTION
• Advanced age is not a contraindication, although
older recipients are at greater risk of perioperative
complications including death.
• Infants less than 1-year of age and geriatric
patients aged 70 years and older are considered
eligible for renal transplant.
SPECIAL SITUATIONS
• Mental Retardation
• Retransplantation
• Female renal transplant candidates
• The HIV positive status
PREOPERATIVE PREPARATION
PREOPERATIVE PREPARATION
• Hemodialysis
• Vascular Access
• Antihypertensive Medication
• Blood Transfusion
Premedication
• Benzodiazepine like diazepam or alprazolam take
care of anxiety of the patient.
• H2-receptor blocker like pantocid are prescribed.
• Morning dose of immunosuppressants and
antihypertensives should be taken.
CHOICE OF ANESTHESIA
• General anesthesia with controlled ventilation is
the technique of choice for renal transplant
patients.
• Regional anesthesia is also practiced in some
centers
• can be done under regional anesthesia– spinal,
epidural and CSE.
• Avoid Intravenous agents that require renal excretion
such as muscle relaxants and opiates.
• The other advantages include avoidance of tracheal
intubation in the immunosuppressed patient.
• In chronic renal failure, the onset of sensory analgesia
occurs faster after subarachnoid blockade
Regional Anesthesia
Disadvantages
of Regional Anesthesia
• The central venous pressure lines and arterial lines have to be
inserted while the patient is awake
• There is a concern over the possibility of extradural hematoma
formation in patients with coagulopathies
• There is difficulty in handling major blood loss
• An unpredictable response of a hypertensive renal patient on
drug therapies to vasopressors
• Maintenance of an awake patient’s well being during a long
procedure
• Medicolegal implications of a postoperative peripheral
neuropathy
• Postdural puncture headache
INTRAOPERATIVE MANAGEMENT
INTRAOPERATIVE MONITORS
• Electrocardiogram
• noninvasive blood pressure
• Pulse oximeter
• Temperature maintenance (Fluid warmer,
Warming blanket (upper body))
• Urine output monitor
• Strict asepsis has to be maintained 
immunosuppressants
• Intraoperative arterial blood gas analysis along
with serum electrolytes is done, after induction,
before and after reperfusion.
• Acid base balance and ventilation should be
maintained
• Avoid Hypovolemia and hypotension
INTRAOPERATIVE MANAGEMENT
• The transplanted patient should be “wet” with a
“supernormal intravascular volume” after opening the
clamps
• Recommended Central venous pressure of 15–20 mm
• Administration of albumin (1.2 g/kg) was associated
with a reduced incidence of delayed graft function.
• Inotropes like dopamine should not be used routinely.
• Inhalational anesthetic agents and opioids are tailored
in such a manner  systolic at or above 140 mmHg to
INTRAOPERATIVE MANAGEMENT (2)
• Drawbacks like prolonged paralysis requiring post-
operative mechanical ventilation, iatrogenic
pulmonary infection and adverse effects of
inhalation agents may be seen.
• Avoiding intraoperative renal insults and
maintaining isovolemia, adequate cardiac output
and renal perfusion pressure are more important
than the choice of a specific anesthetic technique.
INTRAOPERATIVE MANAGEMENT (3)
INTRAOPERATIVE FLUID THERAPY
• Crystalloids are distributed  0.9% saline
devoid of potassium thus minimizing the risk of
electrolyte induced cardiac dysrhythmias.
• Recent study : no difference was found when 0.9%
sodium chloride, Ringer’s lactate or plasmalyte
were given during renal transplant.
• Some protocols recommend normal saline
containing sodium bicarbonate (20 mmol/l) for
volume expansion.
• one year graft survival decreased from 75% with
immediate urine output to only 49% when onset
of diuresis was delayed >12 hours  the
anesthesiologist should aggressively expand the
vascular volume to promote early diuresis during
anesthesia for kidney transplant.
INTRAOPERATIVE FLUID THERAPY (2)
Measures used to Enhance Urine Output
During Kidney Transplant
• Mannitol dose of 0.7–1 g/kg, when renal anastomosis
is commenced
• Loop diuretics: Inhibit na+ K+ ATPase decreasing
tubular oxygen consumption
• An aggressive intraoperative volume expansion by
keeping CVP between 10–15 mmHg is recommended
to avoid acute tubular necrosis secondary to
inadequate intraoperative hydration.
• 20% albumin, 0.8–1.6 ml/kg may improve the graft
survival, urine volume and early graft function
Induction Agents
• Propofol
– PK and PD are unchanged in ESRD patients.
– Infusion dose requirements have also been found to be similar
in ESRD patients and patients with normal renal function
although shorter emergence times have been noted in ESRD
patients when compared with patients with normal renal
function.
• Thiopental
– Almost entirely metabolized in the liver
– Its breakdown products are excreted by the kidneys and the
gastrointestinal tract.
– Traces are excreted unchanged in the urine. No permanent
effects of this agent on kidney function have been recorded.
Neuromuscular Blocking Agents
• Succinylcholine
– should be used with caution in patients with ESRD
– increase serum potassium concentration  cardiac arrhythmias and even cardiac
arrest
• Cisatracurium
– It is metabolized through Hofmann elimination and produces a metabolite,
Laudanosine, which is partially eliminated through the kidneys hence, has a slightly
prolonged elimination half-life in patients with renal failure.
– Is the preferred muscle relaxant in patients with ESRD
• Vecuronium and Rocuronium
– relatively independent of kidney function.
– Metabolized by the liver, but have metabolites that are excreted by the kidney and
liver.
– The duration of action has been reported to be slightly prolonged and a cumulative
effect has been noted with repetitive administration.
Opioids
• Fentanyl, alfentanil, sufentanil
PK and PD are not altered because the metabolites are inactive
and are unlikely to contribute to the opioid effect even if they do
accumulate.
• Remifentanil
- A very short acting opioid,
- metabolized in the peripheral tissues by an esterase enzyme and
requires no change in dosing compared to patients with normal
renal function.
Inhalational Agents
• All potent inhalational agents cause a decrease in the renal
blood flow and glomerular fitration rate in proportion to the
dose.
• Isoflurane, the extent of its metabolism is very small such
that the amount of uoride produced is unlikely to cause
renal damage. It can be used in anesthesia for renal
transplantation.
• Low-flow sevoflurane anesthesia can be safely used in renal
transplant recipients
• Desflurane can also be used in patients with renal
dysfunction and no deterioration in renal function has been
found
Extubation
• Most patients are awake and can be extubated at the
end of the procedure provided the transplanted
kidney has started functioning.
• Maintaining fluid balance and adequate perfusion of
the transplanted kidney is the main task.
• Arterial blood gas analysis is important to ascertain
the hemodynamic status of the patient and corrective
measures should be taken accordingly.
• Oral hydration can be allowed a couple of hours post
transplant.
Postoperative Management
• Kidney transplant unit with skilled staff
• Fluid regimes are variable, depending upon CVP
and urine output of the previous hour. In a stable
patient, oliguria should trigger a surgical review
and urgent doppler imaging of the graft blood
supply.
POSTOPERATIVE COMPLICATIONS
• Acidosis : impaired renal excretion and an
overproduction of acid. At the end of surgery
should not be extubated until corrected
sufficiently to support spontaneous ventilation.
• Sodium bicarbonate should be given slowly by
intravenously when the pH is below normal as
indicated by arterial blood gas analysis
Postoperative Analgesia
• Effective postoperative pain management
contributes to successful outcome after renal
transplant
• Inadequately controlled pain may lead to
agitation, tachycardia, hypertension and increased
risk of respiratory complications.
• Intravenous opioids are the mainstay of analgesia
 Morphine and fentanyl
• Regional blocks like paravertebral block or
transversus abdominal plane block
• Epidural analgesia with narcotics is superior to
parenteral analgesia for postoperative pain relief
 blocks afferent nociceptive stimuli with fewer
side effects.
Postoperative Analgesia (2)
• Nonsteroidal anti inflammatory drugs (nSAIDs) can
cause reversible kidney damage with reduction of
renal blood flow and glomerular filtration rate 
BE AVOIDED!
Postoperative Analgesia (3)
RISK FACTORS AND COMPLICATIONS
1. Graft dysfunction:
Delayed graft function (DGF) is defined as the need for dialysis in
the first week after transplantation due to ischemia—reperfusion
injury
2. Rejection:
a function of the immune system recognizing the transplanted
organ as a foreign body and attempting to destroy it.
Acute rejection, or
Late after transplantation  chronic rejection or chronic allograft
nephropathy or tubular atrophy/interstitial fibrosis.
RISK FACTORS AND COMPLICATIONS (2)
3. Technical complications include:
 Arterial thrombosis or stenosis
 Venous thrombosis
 ureteral leak
 Stenosis or reflux
 Development of fluid collections : hematoma,
seromas, lymphoceles, etc.
 Growth improvement post transplantation ->
controversial
CONCLUSION
Kidney transplant under general anesthesia is the
preferred therapy for chronic kidney disease
patients. Regional anesthesia for kidney transplant is
safe, if there is no coagulopathy in the adult patient.
REFERENCE

More Related Content

What's hot

Renal impairment and anaesthesia
Renal impairment and anaesthesiaRenal impairment and anaesthesia
Renal impairment and anaesthesiaErrol Williamson
 
Anaesthesia for patient with pacemaker
Anaesthesia for patient with pacemakerAnaesthesia for patient with pacemaker
Anaesthesia for patient with pacemakerHASSAN RASHID
 
Anesthesia For Congenital Diaphragmatic Hernia
Anesthesia For Congenital Diaphragmatic HerniaAnesthesia For Congenital Diaphragmatic Hernia
Anesthesia For Congenital Diaphragmatic Herniakrishna dhakal
 
Anaesthesia outside operating room
Anaesthesia outside operating roomAnaesthesia outside operating room
Anaesthesia outside operating roomnarasimha reddy
 
Post anesthesia care unit(PACU)
Post anesthesia care unit(PACU)Post anesthesia care unit(PACU)
Post anesthesia care unit(PACU)HIRANGER
 
Sedation analgesia in icu
Sedation analgesia in icuSedation analgesia in icu
Sedation analgesia in icuAnkit Gajjar
 
Extubation protocol in the OR and ICU
Extubation protocol in the OR and ICUExtubation protocol in the OR and ICU
Extubation protocol in the OR and ICURalekeOkoye
 
Role of Anesthesiologist in Cath Lab
Role of Anesthesiologist in Cath LabRole of Anesthesiologist in Cath Lab
Role of Anesthesiologist in Cath LabAbhijit Nair
 
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)
Ambulatory Anesthesia  and Non–Operating Room Anesthesia (NORA)Ambulatory Anesthesia  and Non–Operating Room Anesthesia (NORA)
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)Saeid Safari
 
Ischemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementIschemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementkrishna dhakal
 
Anesthesia for Liver transplantation - Dr.Sandeep
Anesthesia for Liver transplantation - Dr.SandeepAnesthesia for Liver transplantation - Dr.Sandeep
Anesthesia for Liver transplantation - Dr.Sandeepdeepmbbs04
 
role of anesthesiologist in cathlab
role of anesthesiologist in cathlabrole of anesthesiologist in cathlab
role of anesthesiologist in cathlabRamprasad NNR
 
Anaesthetic considerations for laser surgery
Anaesthetic  considerations for  laser  surgeryAnaesthetic  considerations for  laser  surgery
Anaesthetic considerations for laser surgeryAnamika yadav
 
Magnesium sulphate and anesthesiologist
Magnesium sulphate and anesthesiologistMagnesium sulphate and anesthesiologist
Magnesium sulphate and anesthesiologistdr tushar chokshi
 
Perioperative Management
Perioperative ManagementPerioperative Management
Perioperative ManagementAndrew Ferguson
 
Monitored anaesthesia care
Monitored anaesthesia careMonitored anaesthesia care
Monitored anaesthesia careAnaestHSNZ
 
anaesthesia in chronic kidney disease
anaesthesia in chronic kidney diseaseanaesthesia in chronic kidney disease
anaesthesia in chronic kidney diseasesarmistha panigrahi
 

What's hot (20)

Renal impairment and anaesthesia
Renal impairment and anaesthesiaRenal impairment and anaesthesia
Renal impairment and anaesthesia
 
Anaesthesia for patient with pacemaker
Anaesthesia for patient with pacemakerAnaesthesia for patient with pacemaker
Anaesthesia for patient with pacemaker
 
Anesthesia For Congenital Diaphragmatic Hernia
Anesthesia For Congenital Diaphragmatic HerniaAnesthesia For Congenital Diaphragmatic Hernia
Anesthesia For Congenital Diaphragmatic Hernia
 
Anaesthesia outside operating room
Anaesthesia outside operating roomAnaesthesia outside operating room
Anaesthesia outside operating room
 
Post anesthesia care unit(PACU)
Post anesthesia care unit(PACU)Post anesthesia care unit(PACU)
Post anesthesia care unit(PACU)
 
Sedation analgesia in icu
Sedation analgesia in icuSedation analgesia in icu
Sedation analgesia in icu
 
Extubation protocol in the OR and ICU
Extubation protocol in the OR and ICUExtubation protocol in the OR and ICU
Extubation protocol in the OR and ICU
 
Role of Anesthesiologist in Cath Lab
Role of Anesthesiologist in Cath LabRole of Anesthesiologist in Cath Lab
Role of Anesthesiologist in Cath Lab
 
Anaesthesia for laparoscopic surgeries
Anaesthesia for laparoscopic surgeriesAnaesthesia for laparoscopic surgeries
Anaesthesia for laparoscopic surgeries
 
NON OPERATING ROOM ANAESTHESIA
NON OPERATING ROOM ANAESTHESIANON OPERATING ROOM ANAESTHESIA
NON OPERATING ROOM ANAESTHESIA
 
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)
Ambulatory Anesthesia  and Non–Operating Room Anesthesia (NORA)Ambulatory Anesthesia  and Non–Operating Room Anesthesia (NORA)
Ambulatory Anesthesia and Non–Operating Room Anesthesia (NORA)
 
Ischemic heart disease and anesthetic management
Ischemic heart disease and anesthetic managementIschemic heart disease and anesthetic management
Ischemic heart disease and anesthetic management
 
Anesthesia for Liver transplantation - Dr.Sandeep
Anesthesia for Liver transplantation - Dr.SandeepAnesthesia for Liver transplantation - Dr.Sandeep
Anesthesia for Liver transplantation - Dr.Sandeep
 
role of anesthesiologist in cathlab
role of anesthesiologist in cathlabrole of anesthesiologist in cathlab
role of anesthesiologist in cathlab
 
Anaesthetic considerations for laser surgery
Anaesthetic  considerations for  laser  surgeryAnaesthetic  considerations for  laser  surgery
Anaesthetic considerations for laser surgery
 
Magnesium sulphate and anesthesiologist
Magnesium sulphate and anesthesiologistMagnesium sulphate and anesthesiologist
Magnesium sulphate and anesthesiologist
 
Perioperative Management
Perioperative ManagementPerioperative Management
Perioperative Management
 
Monitored anaesthesia care
Monitored anaesthesia careMonitored anaesthesia care
Monitored anaesthesia care
 
ASRA Guidelines
ASRA GuidelinesASRA Guidelines
ASRA Guidelines
 
anaesthesia in chronic kidney disease
anaesthesia in chronic kidney diseaseanaesthesia in chronic kidney disease
anaesthesia in chronic kidney disease
 

Viewers also liked

Renal transplant: anaesthetic implications & considerations
Renal transplant: anaesthetic implications & considerationsRenal transplant: anaesthetic implications & considerations
Renal transplant: anaesthetic implications & considerationsdrsandeepbmore
 
KIDNEY TRANSPLANTATION SEMINAR PRESENTATION
KIDNEY TRANSPLANTATION SEMINAR PRESENTATIONKIDNEY TRANSPLANTATION SEMINAR PRESENTATION
KIDNEY TRANSPLANTATION SEMINAR PRESENTATIONfareedresidency
 
Evaluation of adult kidney transplant candidates
Evaluation of adult kidney transplant candidatesEvaluation of adult kidney transplant candidates
Evaluation of adult kidney transplant candidatesSunil Kumar Prajapati
 
Kidney transplantation
Kidney transplantationKidney transplantation
Kidney transplantationJijo G John
 
Kidney transplantation candidate evaluation 2016 chaken maniyan
Kidney transplantation candidate evaluation 2016 chaken maniyanKidney transplantation candidate evaluation 2016 chaken maniyan
Kidney transplantation candidate evaluation 2016 chaken maniyanCHAKEN MANIYAN
 
Pre anaesthetic evaluation.pdfx
Pre anaesthetic evaluation.pdfxPre anaesthetic evaluation.pdfx
Pre anaesthetic evaluation.pdfxRAJESH EAPEN
 
Anaesthesia for Liver transplantation
Anaesthesia for Liver transplantationAnaesthesia for Liver transplantation
Anaesthesia for Liver transplantationDr.S.N.Bhagirath ..
 
Preoperative Evaluation
Preoperative EvaluationPreoperative Evaluation
Preoperative EvaluationKhalid
 
Preoperative Assessment (Intro)
Preoperative Assessment (Intro)Preoperative Assessment (Intro)
Preoperative Assessment (Intro)Andrew Ferguson
 
Anesthesia after renal transplant
Anesthesia after renal transplantAnesthesia after renal transplant
Anesthesia after renal transplantDavis Kurian
 
anaesthesia for liver transplantation
anaesthesia for liver transplantationanaesthesia for liver transplantation
anaesthesia for liver transplantationDrUday Pratap Singh
 
Anaesthesia for liver transplantation
Anaesthesia for liver transplantationAnaesthesia for liver transplantation
Anaesthesia for liver transplantationisakakinada
 
Mallemat: The Art and Science of Fluid Responsiveness
Mallemat: The Art and Science of Fluid ResponsivenessMallemat: The Art and Science of Fluid Responsiveness
Mallemat: The Art and Science of Fluid ResponsivenessSMACC Conference
 
Fluid responsiveness - an ICU phoenix
Fluid responsiveness - an ICU phoenixFluid responsiveness - an ICU phoenix
Fluid responsiveness - an ICU phoenixNIICS
 
Fitness for non cardiac surgery 2
Fitness for non cardiac surgery 2Fitness for non cardiac surgery 2
Fitness for non cardiac surgery 2Dharanish Aradhya
 
Inferior Vena Cava Guided Fluid Resuscitation
Inferior Vena Cava Guided Fluid ResuscitationInferior Vena Cava Guided Fluid Resuscitation
Inferior Vena Cava Guided Fluid ResuscitationHon Liang
 

Viewers also liked (20)

Renal transplant: anaesthetic implications & considerations
Renal transplant: anaesthetic implications & considerationsRenal transplant: anaesthetic implications & considerations
Renal transplant: anaesthetic implications & considerations
 
KIDNEY TRANSPLANTATION SEMINAR PRESENTATION
KIDNEY TRANSPLANTATION SEMINAR PRESENTATIONKIDNEY TRANSPLANTATION SEMINAR PRESENTATION
KIDNEY TRANSPLANTATION SEMINAR PRESENTATION
 
Evaluation of adult kidney transplant candidates
Evaluation of adult kidney transplant candidatesEvaluation of adult kidney transplant candidates
Evaluation of adult kidney transplant candidates
 
Kidney transplantation
Kidney transplantationKidney transplantation
Kidney transplantation
 
Kidney transplantation candidate evaluation 2016 chaken maniyan
Kidney transplantation candidate evaluation 2016 chaken maniyanKidney transplantation candidate evaluation 2016 chaken maniyan
Kidney transplantation candidate evaluation 2016 chaken maniyan
 
Pre anaesthetic evaluation.pdfx
Pre anaesthetic evaluation.pdfxPre anaesthetic evaluation.pdfx
Pre anaesthetic evaluation.pdfx
 
Anaesthesia for Liver transplantation
Anaesthesia for Liver transplantationAnaesthesia for Liver transplantation
Anaesthesia for Liver transplantation
 
preanasthetic evaluation
preanasthetic evaluationpreanasthetic evaluation
preanasthetic evaluation
 
Preoperative Evaluation
Preoperative EvaluationPreoperative Evaluation
Preoperative Evaluation
 
Preoperative Assessment (Intro)
Preoperative Assessment (Intro)Preoperative Assessment (Intro)
Preoperative Assessment (Intro)
 
Anesthesia after renal transplant
Anesthesia after renal transplantAnesthesia after renal transplant
Anesthesia after renal transplant
 
anaesthesia for liver transplantation
anaesthesia for liver transplantationanaesthesia for liver transplantation
anaesthesia for liver transplantation
 
Anaesthesia for liver transplantation
Anaesthesia for liver transplantationAnaesthesia for liver transplantation
Anaesthesia for liver transplantation
 
Head injury
Head injuryHead injury
Head injury
 
Donor assessment
Donor assessmentDonor assessment
Donor assessment
 
Ivc guided fluid management in the icu
Ivc guided fluid management in the icuIvc guided fluid management in the icu
Ivc guided fluid management in the icu
 
Mallemat: The Art and Science of Fluid Responsiveness
Mallemat: The Art and Science of Fluid ResponsivenessMallemat: The Art and Science of Fluid Responsiveness
Mallemat: The Art and Science of Fluid Responsiveness
 
Fluid responsiveness - an ICU phoenix
Fluid responsiveness - an ICU phoenixFluid responsiveness - an ICU phoenix
Fluid responsiveness - an ICU phoenix
 
Fitness for non cardiac surgery 2
Fitness for non cardiac surgery 2Fitness for non cardiac surgery 2
Fitness for non cardiac surgery 2
 
Inferior Vena Cava Guided Fluid Resuscitation
Inferior Vena Cava Guided Fluid ResuscitationInferior Vena Cava Guided Fluid Resuscitation
Inferior Vena Cava Guided Fluid Resuscitation
 

Similar to Anesthetic considerations for kidney transplant in an adult

Anaesthesia for renal transplant
Anaesthesia for renal transplantAnaesthesia for renal transplant
Anaesthesia for renal transplantUmang Sharma
 
kidneytrnaplantaion-181204053135.pdf
kidneytrnaplantaion-181204053135.pdfkidneytrnaplantaion-181204053135.pdf
kidneytrnaplantaion-181204053135.pdfSatish Joot
 
Kidney trnaplantaion
Kidney trnaplantaionKidney trnaplantaion
Kidney trnaplantaionPinky Rathee
 
AKI IN ICU.pptx
AKI IN ICU.pptxAKI IN ICU.pptx
AKI IN ICU.pptxHarsh shaH
 
PCP in a Box - Module 3.pptx
PCP in a Box - Module 3.pptxPCP in a Box - Module 3.pptx
PCP in a Box - Module 3.pptxBinti22
 
Nursing Management of patient undergoing renal transplantation.pdf
Nursing Management of patient undergoing renal transplantation.pdfNursing Management of patient undergoing renal transplantation.pdf
Nursing Management of patient undergoing renal transplantation.pdfkarna ram choudhary
 
ECMO Update - ICN NSW 2014
ECMO Update - ICN NSW 2014ECMO Update - ICN NSW 2014
ECMO Update - ICN NSW 2014SMACC Conference
 
Anaesthesia for laparoscopic surgery from ceaccp journal
Anaesthesia for laparoscopic surgery from ceaccp journalAnaesthesia for laparoscopic surgery from ceaccp journal
Anaesthesia for laparoscopic surgery from ceaccp journalChamika Huruggamuwa
 
renal transplantation.pptx
renal transplantation.pptxrenal transplantation.pptx
renal transplantation.pptxshovon2026
 
Care of patients after cardiac surgery @
Care of patients after cardiac surgery @Care of patients after cardiac surgery @
Care of patients after cardiac surgery @SangeetaPatel64
 
Renal transplantation.pptx
Renal transplantation.pptxRenal transplantation.pptx
Renal transplantation.pptxvarts1
 
Kidney Preservation: method and trends
Kidney Preservation: method and trendsKidney Preservation: method and trends
Kidney Preservation: method and trendsKeith Tsui
 
Renal transplantation -friday_prof_ayman refaei
Renal transplantation -friday_prof_ayman refaeiRenal transplantation -friday_prof_ayman refaei
Renal transplantation -friday_prof_ayman refaeiFarragBahbah
 
Hemodialysis Final
Hemodialysis FinalHemodialysis Final
Hemodialysis Finalsakurayel
 
Outcome After Procedures for Retained Blood Syndrome in Coronary Surgery
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryOutcome After Procedures for Retained Blood Syndrome in Coronary Surgery
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryPaul Molloy
 
Renal biopsy fadl
Renal biopsy fadlRenal biopsy fadl
Renal biopsy fadlAhmed Fadl
 

Similar to Anesthetic considerations for kidney transplant in an adult (20)

Anaesthesia for renal transplant
Anaesthesia for renal transplantAnaesthesia for renal transplant
Anaesthesia for renal transplant
 
Eras fast track surgery
Eras fast track surgeryEras fast track surgery
Eras fast track surgery
 
kidneytrnaplantaion-181204053135.pdf
kidneytrnaplantaion-181204053135.pdfkidneytrnaplantaion-181204053135.pdf
kidneytrnaplantaion-181204053135.pdf
 
Kidney trnaplantaion
Kidney trnaplantaionKidney trnaplantaion
Kidney trnaplantaion
 
AKI IN ICU.pptx
AKI IN ICU.pptxAKI IN ICU.pptx
AKI IN ICU.pptx
 
PCP in a Box - Module 3.pptx
PCP in a Box - Module 3.pptxPCP in a Box - Module 3.pptx
PCP in a Box - Module 3.pptx
 
Nursing Management of patient undergoing renal transplantation.pdf
Nursing Management of patient undergoing renal transplantation.pdfNursing Management of patient undergoing renal transplantation.pdf
Nursing Management of patient undergoing renal transplantation.pdf
 
ECMO Update - ICN NSW 2014
ECMO Update - ICN NSW 2014ECMO Update - ICN NSW 2014
ECMO Update - ICN NSW 2014
 
Renal Replacement therapy
Renal Replacement therapyRenal Replacement therapy
Renal Replacement therapy
 
Renal transplant
Renal transplantRenal transplant
Renal transplant
 
Anaesthesia for laparoscopic surgery from ceaccp journal
Anaesthesia for laparoscopic surgery from ceaccp journalAnaesthesia for laparoscopic surgery from ceaccp journal
Anaesthesia for laparoscopic surgery from ceaccp journal
 
renal transplantation.pptx
renal transplantation.pptxrenal transplantation.pptx
renal transplantation.pptx
 
Care of patients after cardiac surgery @
Care of patients after cardiac surgery @Care of patients after cardiac surgery @
Care of patients after cardiac surgery @
 
Renal transplantation.pptx
Renal transplantation.pptxRenal transplantation.pptx
Renal transplantation.pptx
 
Kidney Preservation: method and trends
Kidney Preservation: method and trendsKidney Preservation: method and trends
Kidney Preservation: method and trends
 
Renal transplantation -friday_prof_ayman refaei
Renal transplantation -friday_prof_ayman refaeiRenal transplantation -friday_prof_ayman refaei
Renal transplantation -friday_prof_ayman refaei
 
Fess anesthesia
Fess anesthesiaFess anesthesia
Fess anesthesia
 
Hemodialysis Final
Hemodialysis FinalHemodialysis Final
Hemodialysis Final
 
Outcome After Procedures for Retained Blood Syndrome in Coronary Surgery
Outcome After Procedures for Retained Blood Syndrome in Coronary SurgeryOutcome After Procedures for Retained Blood Syndrome in Coronary Surgery
Outcome After Procedures for Retained Blood Syndrome in Coronary Surgery
 
Renal biopsy fadl
Renal biopsy fadlRenal biopsy fadl
Renal biopsy fadl
 

More from Eko indra

Undescended Testis (UDT)
Undescended Testis (UDT)Undescended Testis (UDT)
Undescended Testis (UDT)Eko indra
 
Laser Techniques for Urinary stones
Laser Techniques for Urinary stonesLaser Techniques for Urinary stones
Laser Techniques for Urinary stonesEko indra
 
Hypogonadotropic Hypogonadism
Hypogonadotropic HypogonadismHypogonadotropic Hypogonadism
Hypogonadotropic HypogonadismEko indra
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile DysfunctionEko indra
 
Premature Ejaculation
Premature EjaculationPremature Ejaculation
Premature EjaculationEko indra
 
Male Infertility
Male InfertilityMale Infertility
Male InfertilityEko indra
 
TURP TECHNIQUE
TURP TECHNIQUETURP TECHNIQUE
TURP TECHNIQUEEko indra
 
Erirs vs pcnl uro fair2019 eko indra
Erirs vs pcnl uro fair2019  eko indraErirs vs pcnl uro fair2019  eko indra
Erirs vs pcnl uro fair2019 eko indraEko indra
 
SEPSIS, SIRS, MOF, AND ARDS
SEPSIS, SIRS, MOF, AND ARDSSEPSIS, SIRS, MOF, AND ARDS
SEPSIS, SIRS, MOF, AND ARDSEko indra
 
TURBT PROCEDURE
TURBT PROCEDURETURBT PROCEDURE
TURBT PROCEDUREEko indra
 
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CAANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CAEko indra
 
Stone & Phlebolith
Stone & PhlebolithStone & Phlebolith
Stone & PhlebolithEko indra
 
Hounsfield Unit
Hounsfield UnitHounsfield Unit
Hounsfield UnitEko indra
 
EXTENDED PYELONEPHROLITHOTOMY
EXTENDED PYELONEPHROLITHOTOMYEXTENDED PYELONEPHROLITHOTOMY
EXTENDED PYELONEPHROLITHOTOMYEko indra
 
Open Pyelolithotomy
Open PyelolithotomyOpen Pyelolithotomy
Open PyelolithotomyEko indra
 
Bladder Capacity
Bladder Capacity Bladder Capacity
Bladder Capacity Eko indra
 
Principles of Endourology
Principles of EndourologyPrinciples of Endourology
Principles of EndourologyEko indra
 
Urologic Ultrasonography
Urologic UltrasonographyUrologic Ultrasonography
Urologic UltrasonographyEko indra
 
Primary endoscopic realignment
Primary endoscopic realignmentPrimary endoscopic realignment
Primary endoscopic realignmentEko indra
 

More from Eko indra (20)

Undescended Testis (UDT)
Undescended Testis (UDT)Undescended Testis (UDT)
Undescended Testis (UDT)
 
Laser Techniques for Urinary stones
Laser Techniques for Urinary stonesLaser Techniques for Urinary stones
Laser Techniques for Urinary stones
 
Hypogonadotropic Hypogonadism
Hypogonadotropic HypogonadismHypogonadotropic Hypogonadism
Hypogonadotropic Hypogonadism
 
Erectile Dysfunction
Erectile DysfunctionErectile Dysfunction
Erectile Dysfunction
 
Premature Ejaculation
Premature EjaculationPremature Ejaculation
Premature Ejaculation
 
Male Infertility
Male InfertilityMale Infertility
Male Infertility
 
TURP TECHNIQUE
TURP TECHNIQUETURP TECHNIQUE
TURP TECHNIQUE
 
Erirs vs pcnl uro fair2019 eko indra
Erirs vs pcnl uro fair2019  eko indraErirs vs pcnl uro fair2019  eko indra
Erirs vs pcnl uro fair2019 eko indra
 
SEPSIS, SIRS, MOF, AND ARDS
SEPSIS, SIRS, MOF, AND ARDSSEPSIS, SIRS, MOF, AND ARDS
SEPSIS, SIRS, MOF, AND ARDS
 
CYSTOSCOPY
CYSTOSCOPYCYSTOSCOPY
CYSTOSCOPY
 
TURBT PROCEDURE
TURBT PROCEDURETURBT PROCEDURE
TURBT PROCEDURE
 
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CAANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA
ANDROGEN DEPRIVATION THERAPHY ON PRASTATE CA
 
Stone & Phlebolith
Stone & PhlebolithStone & Phlebolith
Stone & Phlebolith
 
Hounsfield Unit
Hounsfield UnitHounsfield Unit
Hounsfield Unit
 
EXTENDED PYELONEPHROLITHOTOMY
EXTENDED PYELONEPHROLITHOTOMYEXTENDED PYELONEPHROLITHOTOMY
EXTENDED PYELONEPHROLITHOTOMY
 
Open Pyelolithotomy
Open PyelolithotomyOpen Pyelolithotomy
Open Pyelolithotomy
 
Bladder Capacity
Bladder Capacity Bladder Capacity
Bladder Capacity
 
Principles of Endourology
Principles of EndourologyPrinciples of Endourology
Principles of Endourology
 
Urologic Ultrasonography
Urologic UltrasonographyUrologic Ultrasonography
Urologic Ultrasonography
 
Primary endoscopic realignment
Primary endoscopic realignmentPrimary endoscopic realignment
Primary endoscopic realignment
 

Recently uploaded

historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxkitati1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE Mamatha Lakka
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxLikeways
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxsumanchaulagain3
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).kishan singh tomar
 

Recently uploaded (20)

historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Microbiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptxMicrobiology lecture presentation-1.pptx
Microbiology lecture presentation-1.pptx
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
BENIGN BREAST DISEASE
BENIGN BREAST DISEASE BENIGN BREAST DISEASE
BENIGN BREAST DISEASE
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptxGood Laboratory Practice (GLP) in Pharma-LikeWays.pptx
Good Laboratory Practice (GLP) in Pharma-LikeWays.pptx
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
World-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptxWorld-TB-Day-2023_Presentation_English.pptx
World-TB-Day-2023_Presentation_English.pptx
 
concept of total quality management (TQM).
concept of total quality management (TQM).concept of total quality management (TQM).
concept of total quality management (TQM).
 

Anesthetic considerations for kidney transplant in an adult

  • 1. READ BY : EKO INDRA PRADONO SUPERVISOR : Dr. HASANUL, SpAn, KAP, KIC.
  • 2. INTRODUCTION • Kidney transplantation is a process of attaching new kidneys to replace previously diseased kidneys. • The incidence of end stage renal disease (ESRD) has increased over the past several decades due to an increased incidence of diabetes, obesity and hypertension • Survival and health related quality of life is better after kidney transplantation than after dialysis therapy. • Improvement in immunosuppression regimens which have reduced rates of acute transplant rejection
  • 3. HISTORY OF KIDNEY TRANSPLANT • In 1933, first human renal allograft was performed by Voronoy in the Ukraine. • The recipient was 26 y.o. woman who attempted suicide by ingesting mercury chloride, the donor was 66 y.o man whose kidney was removed 6 hours after death. Patient was death 48 hours after surgery.
  • 4. In 1933, first human renal allograft was performed by Voronoy in the Ukraine. In 1995  First laparoscopic donor nephrectomy was done. In 1977, The first kidney transplant surgery in Indonesia was performed by Prof. dr. R.P. Sidabutar and team at Cipto Mangunkusumo Hospital, Jakarta In 2011  First Laparoscopy living donor nephrectomy (LLDN) was performed at Cipto Mangunkusumo Hospital, Jakarta Until 2015  there were over than 200 Laparoscopic Living Donor Nephrectom (LLDN) performed in RSCM.
  • 5. • From 200 cases, 133 donor (66.5%) Man and 67 (33.5%) Women • The Average age 32,75 YO with SD ±9,45 • 165 LLDN (82,5%) performed in left kidney and 35 procedure (17,5%) performed in right kidney
  • 6. Kidney Transplant Center in Indonesia – RSCM Jakarta: 3 times / week – Cikini Hospital – Surabaya – RSPAD Gatot Subroto – Bandung – Yogyakarta – Malang – Medan ?
  • 7. Kidney Transplant in Indonesia Initiated in 1977 Data for RSCM and Cikini CCI is updated for mid 2012 Data for remaining hospitals is updated for 2010 Courtesy of Situmorang GR, Wahyudi I, Siahaan E, et al
  • 8. Survival Analysis Courtesy of Situmorang GR, Wahyudi I, Siahaan E, et al
  • 9. RIGHT VS LEFT LLDN A single-centre RCT revealed no differences between left- and right-sided donor nephrectomy in donor hospital stay, donor quality of life, donor and acceptor complication rates, or graft survival Parameters Left LLDN (n=82) Right LLDN (n=18) P value Operating time (min) 262.9 ± 50.0 253.1 ± 42.0 0.44* Blood loss (ml) 269.9 ± 52.4 230.6 ± 49.1 0.55* Length of hospital stay (days) 4.6± 1.4 4.5 ± 1.4 0.86* Warm ischemic time (min) 6.2 ± 3.4 5.7 ± 2.5 0.60* LLDN in Cipto Mangunkusumo Hospital (Nov 2011 – Now)
  • 10. The Technique Renal transplantation surgery includes : A. Retrieval of kidney from live/deceased donor-Donor nephrectomy Live/Cadaveric B. Placement of donor kidney into the recipient’s body  renal transplantation The kidney removal from a prospective live kidney donor is either by an open approach or by a laparoscopic approach.
  • 11. Living Donor Nephrectomy • accepted by law, religion and bioethics, provided that the donor is aware of the consequences of his/her act and makes the decision without outside prenure or commercialism. • Once the prospective donor is medically fit for donation, the last step is surgical evaluation  assessment of the anatomic features of the donor kidney  nephrectomy can safely be performed? CT Angiografi
  • 12. POSITION Modified lateral decubitus position with hips rotated back and arm extended above the head. The table is flexed to expand the area between the costal margin and pelvic brim.
  • 13. LLDN
  • 14. LLDN
  • 15. RECIPIENT SURGERY • The general preparation and selection of recipient commences with the nephrological evaluation and ends with evaluation by the transplant surgeon. • After induction of anesthesia and placement of central and arterial lines, the recipient is prepared and draped from nipple to mid thigh. • A third generation cephalosporin is given at time of induction. • A three way urinary catheter is placed with full aseptic precautions and unobstructed drainage is ensured.
  • 17. MULTISYSTEM DYSFUNCTION 1. Cardiovascular Hypertension, ischemic heart disease, cardiac failure, pericarditis 2. Respiratory Pulmonary edema, pleural effusion, respiratory infection 3. Gastrointestinal Stress ulceration, delayed gastric emptying, malnutrition 4. Central nervous Peripheral neuropathy, autonomic neuropathy, mental slowing, convulsions, coma
  • 18. 5. Renal Fluid and electrolyte imbalance, altered pharmacokinetics and pharmacodynamics 6. Hematological Anemia, coagulopathies 7. Immunological Immunosuppression 8. Dialysis related problems a. Peritonitis (peritoneal dialysis) b. Systemic anticoagulation c. Vascular access d. Dementia MULTISYSTEM DYSFUNCTION (2)
  • 21. TIMELINE OF RECIPIENT KIDNEY TRANSPLANT Expected length of stay 5 days Preparation at outpatient clinic for laboratory test and imaging H-1 days  Donor is hospitalized. Consultation to others department Preparation of surgery equipment, Blood preparation 300 cc of PRC Day of Surgery H+1  aff drain if production < 50 ml, aff epidural catheter H+2 aff urethral catheter 1st week after surgery  follow up at outpatient clinic, aff hecting 1st year after surgery  follow up at outpatient clinic, evaluation general condition and kidney function
  • 22. PATIENT SELECTION • Advanced age is not a contraindication, although older recipients are at greater risk of perioperative complications including death. • Infants less than 1-year of age and geriatric patients aged 70 years and older are considered eligible for renal transplant.
  • 23. SPECIAL SITUATIONS • Mental Retardation • Retransplantation • Female renal transplant candidates • The HIV positive status
  • 25. PREOPERATIVE PREPARATION • Hemodialysis • Vascular Access • Antihypertensive Medication • Blood Transfusion
  • 26. Premedication • Benzodiazepine like diazepam or alprazolam take care of anxiety of the patient. • H2-receptor blocker like pantocid are prescribed. • Morning dose of immunosuppressants and antihypertensives should be taken.
  • 27. CHOICE OF ANESTHESIA • General anesthesia with controlled ventilation is the technique of choice for renal transplant patients. • Regional anesthesia is also practiced in some centers
  • 28. • can be done under regional anesthesia– spinal, epidural and CSE. • Avoid Intravenous agents that require renal excretion such as muscle relaxants and opiates. • The other advantages include avoidance of tracheal intubation in the immunosuppressed patient. • In chronic renal failure, the onset of sensory analgesia occurs faster after subarachnoid blockade Regional Anesthesia
  • 29. Disadvantages of Regional Anesthesia • The central venous pressure lines and arterial lines have to be inserted while the patient is awake • There is a concern over the possibility of extradural hematoma formation in patients with coagulopathies • There is difficulty in handling major blood loss • An unpredictable response of a hypertensive renal patient on drug therapies to vasopressors • Maintenance of an awake patient’s well being during a long procedure • Medicolegal implications of a postoperative peripheral neuropathy • Postdural puncture headache
  • 31. INTRAOPERATIVE MONITORS • Electrocardiogram • noninvasive blood pressure • Pulse oximeter • Temperature maintenance (Fluid warmer, Warming blanket (upper body)) • Urine output monitor
  • 32. • Strict asepsis has to be maintained  immunosuppressants • Intraoperative arterial blood gas analysis along with serum electrolytes is done, after induction, before and after reperfusion. • Acid base balance and ventilation should be maintained • Avoid Hypovolemia and hypotension INTRAOPERATIVE MANAGEMENT
  • 33. • The transplanted patient should be “wet” with a “supernormal intravascular volume” after opening the clamps • Recommended Central venous pressure of 15–20 mm • Administration of albumin (1.2 g/kg) was associated with a reduced incidence of delayed graft function. • Inotropes like dopamine should not be used routinely. • Inhalational anesthetic agents and opioids are tailored in such a manner  systolic at or above 140 mmHg to INTRAOPERATIVE MANAGEMENT (2)
  • 34. • Drawbacks like prolonged paralysis requiring post- operative mechanical ventilation, iatrogenic pulmonary infection and adverse effects of inhalation agents may be seen. • Avoiding intraoperative renal insults and maintaining isovolemia, adequate cardiac output and renal perfusion pressure are more important than the choice of a specific anesthetic technique. INTRAOPERATIVE MANAGEMENT (3)
  • 35. INTRAOPERATIVE FLUID THERAPY • Crystalloids are distributed  0.9% saline devoid of potassium thus minimizing the risk of electrolyte induced cardiac dysrhythmias. • Recent study : no difference was found when 0.9% sodium chloride, Ringer’s lactate or plasmalyte were given during renal transplant. • Some protocols recommend normal saline containing sodium bicarbonate (20 mmol/l) for volume expansion.
  • 36. • one year graft survival decreased from 75% with immediate urine output to only 49% when onset of diuresis was delayed >12 hours  the anesthesiologist should aggressively expand the vascular volume to promote early diuresis during anesthesia for kidney transplant. INTRAOPERATIVE FLUID THERAPY (2)
  • 37. Measures used to Enhance Urine Output During Kidney Transplant • Mannitol dose of 0.7–1 g/kg, when renal anastomosis is commenced • Loop diuretics: Inhibit na+ K+ ATPase decreasing tubular oxygen consumption • An aggressive intraoperative volume expansion by keeping CVP between 10–15 mmHg is recommended to avoid acute tubular necrosis secondary to inadequate intraoperative hydration. • 20% albumin, 0.8–1.6 ml/kg may improve the graft survival, urine volume and early graft function
  • 38. Induction Agents • Propofol – PK and PD are unchanged in ESRD patients. – Infusion dose requirements have also been found to be similar in ESRD patients and patients with normal renal function although shorter emergence times have been noted in ESRD patients when compared with patients with normal renal function. • Thiopental – Almost entirely metabolized in the liver – Its breakdown products are excreted by the kidneys and the gastrointestinal tract. – Traces are excreted unchanged in the urine. No permanent effects of this agent on kidney function have been recorded.
  • 39. Neuromuscular Blocking Agents • Succinylcholine – should be used with caution in patients with ESRD – increase serum potassium concentration  cardiac arrhythmias and even cardiac arrest • Cisatracurium – It is metabolized through Hofmann elimination and produces a metabolite, Laudanosine, which is partially eliminated through the kidneys hence, has a slightly prolonged elimination half-life in patients with renal failure. – Is the preferred muscle relaxant in patients with ESRD • Vecuronium and Rocuronium – relatively independent of kidney function. – Metabolized by the liver, but have metabolites that are excreted by the kidney and liver. – The duration of action has been reported to be slightly prolonged and a cumulative effect has been noted with repetitive administration.
  • 40. Opioids • Fentanyl, alfentanil, sufentanil PK and PD are not altered because the metabolites are inactive and are unlikely to contribute to the opioid effect even if they do accumulate. • Remifentanil - A very short acting opioid, - metabolized in the peripheral tissues by an esterase enzyme and requires no change in dosing compared to patients with normal renal function.
  • 41. Inhalational Agents • All potent inhalational agents cause a decrease in the renal blood flow and glomerular fitration rate in proportion to the dose. • Isoflurane, the extent of its metabolism is very small such that the amount of uoride produced is unlikely to cause renal damage. It can be used in anesthesia for renal transplantation. • Low-flow sevoflurane anesthesia can be safely used in renal transplant recipients • Desflurane can also be used in patients with renal dysfunction and no deterioration in renal function has been found
  • 42. Extubation • Most patients are awake and can be extubated at the end of the procedure provided the transplanted kidney has started functioning. • Maintaining fluid balance and adequate perfusion of the transplanted kidney is the main task. • Arterial blood gas analysis is important to ascertain the hemodynamic status of the patient and corrective measures should be taken accordingly. • Oral hydration can be allowed a couple of hours post transplant.
  • 43. Postoperative Management • Kidney transplant unit with skilled staff • Fluid regimes are variable, depending upon CVP and urine output of the previous hour. In a stable patient, oliguria should trigger a surgical review and urgent doppler imaging of the graft blood supply.
  • 44. POSTOPERATIVE COMPLICATIONS • Acidosis : impaired renal excretion and an overproduction of acid. At the end of surgery should not be extubated until corrected sufficiently to support spontaneous ventilation. • Sodium bicarbonate should be given slowly by intravenously when the pH is below normal as indicated by arterial blood gas analysis
  • 45. Postoperative Analgesia • Effective postoperative pain management contributes to successful outcome after renal transplant • Inadequately controlled pain may lead to agitation, tachycardia, hypertension and increased risk of respiratory complications.
  • 46. • Intravenous opioids are the mainstay of analgesia  Morphine and fentanyl • Regional blocks like paravertebral block or transversus abdominal plane block • Epidural analgesia with narcotics is superior to parenteral analgesia for postoperative pain relief  blocks afferent nociceptive stimuli with fewer side effects. Postoperative Analgesia (2)
  • 47. • Nonsteroidal anti inflammatory drugs (nSAIDs) can cause reversible kidney damage with reduction of renal blood flow and glomerular filtration rate  BE AVOIDED! Postoperative Analgesia (3)
  • 48. RISK FACTORS AND COMPLICATIONS 1. Graft dysfunction: Delayed graft function (DGF) is defined as the need for dialysis in the first week after transplantation due to ischemia—reperfusion injury 2. Rejection: a function of the immune system recognizing the transplanted organ as a foreign body and attempting to destroy it. Acute rejection, or Late after transplantation  chronic rejection or chronic allograft nephropathy or tubular atrophy/interstitial fibrosis.
  • 49. RISK FACTORS AND COMPLICATIONS (2) 3. Technical complications include:  Arterial thrombosis or stenosis  Venous thrombosis  ureteral leak  Stenosis or reflux  Development of fluid collections : hematoma, seromas, lymphoceles, etc.  Growth improvement post transplantation -> controversial
  • 50. CONCLUSION Kidney transplant under general anesthesia is the preferred therapy for chronic kidney disease patients. Regional anesthesia for kidney transplant is safe, if there is no coagulopathy in the adult patient.