Dai Chenyang, Shi Pengcai, Liu Binghua, Feng Dan, Liu Mengjie and Wang yuelan
Objective: To keep different levels of blood pressure and to observe the effects on the posttransplant renal function under general anesthesia.
Methods: We selected 20 patients with the renal normal function (group N, n=20) who undergoing live donor nephrectomy under general anesthesia; the renal failure group (group F n=20) who undergoing renal transplantation. Blood pressure, ECG, SpO2, PETCO2, BIS were monitored continuously. Levels of norepinephrine, epinephrine, aldosterone in blood plasma were measured before anesthesia, after anesthesia before skin incision, at the time point of kidney exploration and after nephrectomy 10 min,40 min,120 min or at the renal vascular anastomosis opened for 10 min, 40 min, 120 min and even for 1st, 3rd days after kidney transplant. Meanwhile, we detected the volume of urine, serum concentrations of Cr (Creatinine), BUN (Blood urea nitrogen), cystsin C (CysC) and β2 microglobulin (β2-MG) for group F1(using the vasoactive drug to maintain the SBP 160-140 mmHg) and group F2 (SBP was kept at 139-110 mmHg) at different time points during the donor’s kidney was transplanted.
Results: 1. Aldosterone was increased significantly at kidney exploration or the renal vascular anastomosis, comparied to pre-induction (P<0.05). But, there were no difference between two groups at each time points. 2. The volume of urine was increased as the time going on after kidney replacement in group F1 and F2. Meanwhile, The serum concentrations of Cr, BUN, CysC and β2-MG were decreased at the T4,T5,1st, 3rd time points, But there were no difference between F2 and F2 groups at each time point.
Conclusion: The renin angiotensin aldosterone system was active in renal function normal or failure patients in peri-operation. And the transplanted kidney could work well under the physiologic levels of blood pressure and the higher SBP might not be essential in the renal failure patients.