Anaesthesia for renal transplantation--5 years' experience

Two hundred and seventy patients underwent anaesthesia for 280 renal transplants between October 1977 and October 1982. Their medical records were studied retrospectively. These patients were representative of the end-stage chronic renal failure population, with the usual high incidence of cardiovascular and biochemical abnormalities. Most received general anaesthesia, with an intravenous barbiturate, muscle relaxant, narcotic and volatile supplement sequence being the most common. There were no intra-operative deaths. One postoperative death was felt to be influenced by the anaesthetic management. Four patients had life-threatening cardiac complications and a further four required postoperative respiratory support, three for delayed recovery of neuromuscular function and one for "recurarisation". Less serious complications were considerably more common. General anaesthesia utilising suxamethonium and tubocurarine as the relaxants and halothane as the volatile supplement is least likely to result in complications. Changes to this anaesthetic sequence are likely with the introduction of new agents.