Anesthesia for renal transplantation: continuous neuromuscular blockade with atracurium and the management of intraoperative hypertension with nifedipine
Blobner, M.; Felber, A.R.; Jelen, G.; Gögler, S.; Jelen-Esselborn, S.
Anaesthesiologie und Reanimation 18(4): 92
1993
ISSN/ISBN: 0323-4983 PMID: 8240642 Document Number: 416424
Patients undergoing kidney transplantation often suffer from essential hypertension and coronary artery disease, for which perioperative treatment with nifedipine proved to be effective. If calcium-channel blockers and nondepolarizing muscle relaxants are used simultaneously, their synergistic effect at the neuromuscular cleft must be considered. On the other hand because of its extrarenal elimination no significantly altered effects are expected for patients with terminal renal failure. This prospective study comprised 30 patients undergoing kidney transplantation who were 2 kg over normal weight after a preoperative dialysis and infusion of lactated Ringer solution. Fifteen minutes after introduction of balanced anaesthesia with isoflurane, nitrous oxide and fentanyl, patients were assigned to the treatment group (N) with hypertension (mean arterial pressure (MAP > 110 mmHg) and subsequent management with nifedipine or to the control group (0). Treatment was aimed at keeping MAP between 90 and 110 mmHg. The neuromuscular status was electromyographically assessed by the train-of-four-principle. There were evaluated the duration of action of the initial dose of atracurium (0.5 mg/kg) from injection time to T1 = 2% (WZ 2), the dose of atracurium for a continuous neuromuscular blockade (DD 98 in mg/kg/h), the recovery time and the recovery index. Fourteen patients with hypertension received a bolus of 10 micrograms/kg nifedipine. A significant reduction in blood pressure (p < 0.05) to the desired range was achieved by a subsequent infusion of nifedipine of 5 to 40 micrograms/kg/h. In 16 patients MAP was kept between 90 and 100 mmHg without any additional therapy.