[Anesthetic management of combined kidney and pancreas transplantation]

Combined kidney and pancreas transplantation was performed for the first time in Japan in a 29-year-old diabetic male with end stage renal nephropathy. He previously required injections of 44 IU insulin daily, and the fasting plasma glucose concentration before the transplant was 722 mg/dl. Anesthesia was maintained with fentanyl, nitrous oxide (70%) and halothane (0 approximately 1.0%). A continuous infusion of intravenous regular insulin (2 approximately 8 IU/hr) was started after induction of anesthesia. After revascularization of the pancreatic graft, his plasma glucose concentration fell from 350 mg/dl to 130 mg/dl in one hour and a half. Blood glucose level was maintained between 200 to 300 mg/dl without insulin during anesthesia and thereafter. The grafted kidney and pancreas showed good function during this period. In this report, anesthetic problems in combined kidney and pancreas transplantation were discussed.