[Intra-operative management during laparotomy for patients under hemodialysis]

We evaluated retrospectively 31 patients under hemodialysis who underwent scheduled laparotomy with a purpose to determine the optimal intra-operative water balance. The patients fell into two different periods according to the difference of the principle of anesthesia. Anesthesia method employed for the former eleven patients (1987.6-1990.12) was NLA with pancuronium for muscle relaxation and they were ventilated mechanically in ICU. More recent twenty patients (1991-1995) had epidural block plus nitrous oxide-oxygen-isoflurane with vecuronium and they were extubated early. These latter patients, compared with the preoperative values, did not show any significant changes in mean arterial pressure or systemic vascular resistance after the operation. Intra-operative water balance showed a positive correlation with PADP (r = 0.57) and a negative correlation with SVR (r = 0.36) at the end of operation. The adequate fluid infusion is necessary to maintain PADP, and the water balance of +3-5 ml x kg-1 x hr-1 is recommended during laparotomy for the patients under hemodialysis.