[Anesthetic maintenance of renal transplantation in children]

For many children with severe renal excretory dysfunction, renal transplantation is the sole method of life prolongation. The purpose of the investigation was to analyze the specific features of anesthetic maintenance of transplantation of related and cadaver kidney at 1 to 5 years. The investigation involved a detailed analysis of the specific features of 101 anesthesias made in children aged 1 to 16 years (mean 9.6+/-4.87 years) during transplantation of kidneys from corpses and apparently healthy relatives. The duration of surgery and anesthesia was 5.6+/-1.00 and 7.6+/-1.42 hours, respectively. Operations were made under balanced general anesthesia using a low-flow inhalational isoflurane or sevoflurane (0.5-2.0 MAC) technology. After inclusion of a graft into the bloodstream, a plasmapheresis procedure was initiated in 1-1.5 circulating blood volumes. All the children underwent invasive hemodynamic monitoring: the radial artery and internal jugular vein were catheterized. In 19 cases, the pulmonary artery was catheterized using a Swan-Ganz catheter. In children, the initial period of anesthesia during renal transplantation was marked by a drastic hemodynamic instability tended for hypotension and significant tachycardia in the presence of marked hypovolemia (central venous pressure = 0+/-2.0 mm Hg). The major component of infusion therapy was freshly frozen plasma (up to 50% of the volume). Inclusion of a cold renal graft into systemic circulation and washout of residues of preservative solution and necrobiolysis products from it were accompanied by a 0.5-1.3 degrees C temperature reduction and progression of metabolic acidosis. Safe and successful anesthetic maintenance of renal transplantation in children requires an obligatory informative invasive hemodynamic monitoring, continuous laboratory screening, and knowledge of stage-specific features. Continuous plasmapheresis by means of a plasma filter is preferred.