Combination of epidural anaesthesia and general anaesthesia attenuates stress response to renal transplantation surgery.
Hadimioglu N, Ulugol H, et al.Transplantation Proceedings 2012; 44(10): 2949-54.
Aims
To compare the effect of epidural anaesthesia plus general anaesthesia with general anaesthesia alone on attenuating a stress response in renal transplant recipients.
Interventions
General anaesthesia was induced with thiopental (3-5 mg/kg) and fentanyl (2µg/kg) in both groups, and maintained with desflurane (3%-5%) in 50% O₂-air mixture. The epidural anaesthesia group were administered a with 0.5% bupivacain (14-18mL) via an epidural catheter. In this group, patient controlled analgesia with morphine from the epidural catheter was administered at the start of skin closure.
Participants
50 non-diabetic patients, scheduled to receive living related renal transplantation.
Outcomes
Hospital stays in both groups, in addition to creatinine levels before transplantation on the first day and 6 months after transplantation.
Follow-up
6 months
CET Conclusions
In this un-blinded clinical comparison of modest quality of anaesthetic techniques, epidural anaesthesia in combination with general anaesthesia was compared to general anaesthesia alone for renal transplant recipients. At the end of surgery serum glucose levels were significantly higher in the general anaesthetic group, but returned to the same levels as the combined anaesthesia group from 1 hour post-op to 24 hours post-op. A similar profile was seen for serum insulin whilst the HOMA-IR score (an estimate of insulin resistance) was improved at all time points in the combined anaesthesia group. Serum TNF alpha levels showed a persistent increase in the general anaesthesia group compared to a steady decrease in the combined anaesthesia group that may be related to improving renal function, although no difference in renal function was seen at 6 months. No difference was seen in resistin and adiponectin levels. Hospital stay was reduced in the combined anaesthesia group.
Data analysis
Available case analysis
Trial registration
Not reported.