Neurolept anaesthesia for the renal transplant operation

Between October 1973 and December 1976, neurolept anesthesia was used in 176 consecutive renal transplantations carried out in 155 patients. For premedication, the combination either of droperidol, diazepam and atropine or of oxicon and scopolamine was used; the latter was found to be more effective. The induction agent was droperidol or thiomebumal sodium, the barbiturate being found to be preferable. For maintenance, nitrous oxide and fentanyl were employed. Pancuronium was given as a muscle relaxant. The fact that the patients belonged to a high-risk category as regards anesthesia was apparent from the frequent occurrence of abnormal features in the heart-lung radiographs (47%) and ECG (53%). As could be expected in uraemic patients, anaemia and hypertension were fairly common. Induction was followed by a marked fall in blood pressure in 30% of the patients. During anaesthesia, there was a drop in blood pressure of more than 30% of the initial value in 35% of the patients, usually associated with a blood loss. In the majority of cases the course the anaesthesia was uneventful. In four patients (2.3%), the onset of respiration was delayed and re-intubation was resorted to. One patient developed arrhythmia requiring treatment. There was no evidence of nephrotoxicity. The per- and postoperative mortality was nil. The findings in this series indicate that neurolept anaesthesia is suitable for renal transplant operation.