Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2019.06.002
Brazilian Journal of Anesthesiology
Scientific Article

Anesthesia for renal transplantation in patients with dilated cardiomyopathy: a retrospective study of 31 cases

Anestesia para transplante renal em pacientes com cardiomiopatia dilatada: estudo retrospectivo de 31 casos

Vipin Kumar Goyal, Priyamvada Gupta, Birbal Baj

Downloads: 0
Views: 81

Abstract

Background and objectives
Dilated cardiomyopathy is a state of progressive enlargement of cardiac chambers mainly left ventricle which leads to decreased cardiac output and ultimately cardiac failure. Although it has multifactorial aetiology, it is quite common in patients with end stage renal disease who require renal transplant surgery for their cure. Both conditions go side by side and anesthetic management of such cases poses real challenge to anesthesiologist. Strict monitoring and control of cardiac physiology is of utmost importance besides meticulous fluid management, thus preserving renal blood flow on one hand and preventing cardiac failure on other hand. This is the basis of achieving good outcome of the renal transplant surgery.

Methods
This is a retrospective observational study done by analysing electronic database of 31 patients with dilated cardiomyopathy who underwent renal transplant surgery. Data was studied in terms of demographics, duration of renal disease, comorbidities mainly hypertension, cardiac echo graphic findings including ejection fraction, medications and post‐operative outcome.

Results
Most common perioperative complication in this patient population was hypotension (51.61%) followed by pulmonary complications (postoperative mechanical ventilation (12.9%) and pulmonary edema (6.45%). High incidence of hypotension may be a causative factor to increased rate of delayed graft functioning (12.9%) and acute tubular necrosis (2.23%) in these patients.

Conclusion
Strict monitoring and control of hemodynamic parameters as well as meticulous fluid therapy is the cornerstone in improving outcome in patients with dilated cardiomyopathy undergoing renal transplant surgery.

Keywords

Anesthetic management; Dilated cardiomyopathy; Non‐cardiac surgery; Renal transplant; Systolic dysfunction

Resumo

Justificativa e objetivos
A cardiomiopatia dilatada é um estado de aumento progressivo das câmaras cardíacas, principalmente do ventrículo esquerdo, que leva à diminuição do débito cardíaco e, por fim, à insuficiência cardíaca. Embora tenha etiologia multifatorial, é bastante comum em pacientes com doença renal terminal que precisam de transplante renal para sua cura. Ambas as condições andam lado a lado e o manejo anestésico de tais casos é um verdadeiro desafio para o anestesiologista. A monitoração e o controle rigorosos da fisiologia cardíaca são de extrema importância, além de um meticuloso manejo dos líquidos, o que por um lado preserva o fluxo sanguíneo renal, por outro previne a insuficiência cardíaca. Essa é a base para alcançar o bom resultado da cirurgia de transplante renal.

Métodos
Este estudo observacional retrospectivo foi feito mediante a análise de prontuários eletrônicos de 31 pacientes com cardiomiopatia dilatada submetidos à cirurgia de transplante renal. Os dados foram avaliados em termos demográficos, duração da doença renal, comorbidades (principalmente hipertensão), achados ecocardiográficos (inclusive fração de ejeção), medicamentos e resultados no pós‐operatório.

Resultados
A complicação perioperatória mais comum nessa população de pacientes foi hipotensão (51,61%), seguida de complicações pulmonares, como ventilação mecânica pós‐operatória (12,9%) e edema pulmonar (6,45%). A alta incidência de hipotensão pode ser um fator causador do aumento da incidência de atraso no funcionamento do enxerto (12,9%) e necrose tubular aguda (2,23%) nesses pacientes.

Conclusão
A monitoração rigorosa e o controle dos parâmetros hemodinâmicos, bem como a fluidoterapia criteriosa, são a pedra angular na melhoria dos resultados em pacientes com cardiomiopatia dilatada submetidos à cirurgia de transplante renal.

Palavras-chave

Manejo anestésico; Cardiomiopatia dilatada; Cirurgia não cardíaca; Transplante renal; Disfunção sistólica

References

1 P.H. Thiagarajah, S. Thiagarajah, E.A. Frost Anaesthetic considerations in patients with cardiomyopathies ? a review Middle East J Anesthesiol., 20 (2009), pp. 347-354

2 A. Luk, E. Ahn, G.S. Soor, J. Butany Dilated cardiomyopathy: a review J Clin Pathol., 62 (2009), p. 219

3 B.S. Martinez, I. Gasanova, A.O. Adesanya Anaesthesia for kidney transplantation ? a review J Anesth Clin Res., 4 (2013), pp. 1-6

4 V.K. Goyal, S.L. Solanki, B. Baj, et al. Pulmonary hypertension and post‐operative outcome in renal transplant: A retrospective analysis of 170 patients Indian J Anaesth., 62 (2018), pp. 131-135

5 C.B. Josephson, D. Delgado, J. Schiff, et al. The effectiveness of renal transplantation as a treatment for recurrent uremic cardiomyopathy Can J Cardiol., 24 (2008), pp. 315-317

6 B.A. Koplan, W.G. Stevenson Ventricular tachycardia and sudden cardiac death Mayo Clin Proc., 84 (2009), pp. 289-297

7 E. Koutalas, E. Kanoupakis, P. Vardas Sudden cardiac death in non‐ischemic dilated cardiomyopathy: A critical appraisal of existing and potential risk stratification tools Int J Cardiol., 167 (2013), pp. 335-341

8 D. Poldermans, J.J. Bax, E. Boersma, et al. Guidelines for pre‐operative cardiac risk assessment and perioperative cardiac management in non‐cardiac surgery European Heart Journal., 30 (2009), pp. 2769-2812

9 M. Shibuya, N. Kamekura, Y. Kimura, et al. Clinical study of anaesthetic management during dental treatment of 25 patients with cardiomyopathy Spec Care Dentist., 23 (2003), pp. 216-222

10 R. Juneja, P.M. Nambiar Cardiomyopathies and anaesthesia Indian J Anaesth., 61 (2017), pp. 728-735

11 D. Srivastava, T. Tiwari, S. Sahu, et al. Anaesthetic management of renal transplant surgery in patients of dilated cardiomyopathy with ejection fraction less than 40% Anesthesiol Res Pract., 2014 (2014), pp. 525-969

12 G. Bhosale, V. Shah Combined spinal‐epidural anesthesia for renal transplantation Transplantation Proc., 40 (2008), pp. 1122-1124

13 K. Holte, N.E. Sharrock, H. Kehlet Pathophysiology and clinical implications of perioperative fluid excess Br J Anaesth., 89 (2002), pp. 622-632

14 M.S. Strunden, K. Heckel, A.E. Goetz, et al. Perioperative fluid and volume management: physiological basis, tools and strategies Ann intensive Care., 1 (2011), p. 2

5dc5a7da0e8825e616593253 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections