[Use of Diprivan in renal insufficiency]

The use of propofol for induction and maintenance of anaesthesia in end-stage chronic renal failure has been reported in many publications. The rather minor pharmacokinetic changes of propofol recorded in patients with end-stage chronic renal failure are in favour of the absence of accumulation of agent, and is a good reason for its use in this context. Acute variations in potassium plasma concentrations or acid-base balance have been observed neither in healthy subjects nor in end-stage chronic renal failure, after administration of propofol. Effects of propofol on known impaired renal function have not been studied, apart from renal transplantation. Therefore, postoperative monitoring of renal function is essential, as haemodynamic variations elicited by the administration of propofol contribute to its aggravation. These haemodynamic variations depend on the dose, the rate of administration, the underlying cardiovascular condition and the blood volume of the patient. Due to inter-patient variability in clinical and laboratory parameters, the dose required for a stable anaesthesia varies with the each patient. Careful, slow administration ensures easier titration of the required dose, keeping any secondary haemodynamic side-effects to a minimum. In these patients the quality and speed of recovery depends on the type and dose of agents associated with propofol to maintain anaesthesia. Nitrous oxide, in reducing the need for opioids, should shorten the recovery period. Monitoring of cyclosporine blood concentrations after anaesthesia using propofol is mandatory in renal transplant patients.