ANESTHESIOLOGY FAST REVIEW

ANESTHESIOLOGY_FAST_REVIEWKAPAK1-0-25

RENAL ANESTHESIA

Esra Göger

Konya City Hospital, Department of Anesthesiology and Reanimation, Konya, Türkiye

Göger E. Renal Anesthesia. In: Kazancı D, editor. Anesthesiology Fast Review. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.317-327.

ABSTRACT

  • The kidneys are highly sensitive to perioperative changes, with GFR as the primary renal health marker. Anesthesia can reduce renal blood flow, GFR, and urine output.
  • Neuraxial anesthesia has a lesser impact on renal function compared to general anesthesia, which can influence renal perfusion and hormonal regulation.
  • Desflurane and sevoflurane are modern inhalation agents of choice. However, low-flow sevoflurane use is cautioned due to Compound A nephrotoxicity risks.
  • Propofol and midazolam are relatively safe but require dose adjustments in renal impairment. Morphine may accumulate, leading to prolonged sedation.
  • Includes BUN, serum creatinine, and creatinine clearance evaluations. Additional considerations include anemia, fluid overload, and hypovolemia risks.
  • Maintaining stable hemodynamics, avoiding blood pressure measurement on AV fistula arms, and selecting muscle relaxants based on potassium levels are critical.
  • Minimizing blood loss and using transesophageal echocardiography (TEE) for thrombus assessment is crucial. Epidural analgesia aids in recovery.
  • Cisatracurium is preferred due to non-renal excretion. Proper fluid management ensures graft viability, while hyperkalemia risks are reduced by rinsing the donor kidney before reperfusion.

Keywords: Anesthesia; Analgesia; Acute kidney injury; Kidney neoplasm; Kidney transplantion

Referanslar

  1. Quaia E, Martingano P, Cavallaro M, Premm M, Angileri R. Normal radiological anatomy and anatomical variants of the kidney Springer Berlin Heidelberg. 2014:17-74. [Crossref]
  2. Wing EJ, Schiffman FJ. (Eds.) Cecil Essentials of MedicineE-Book: Cecil Essentials of Medicine E-Book. Elsevier Health Sciences. 2021;508-20. [Link]
  3. Singh P, Ricksten SE, Bragadottir G, Redfors B, Nordquist L. Renal oxygenation and haemodynamics in acute kidney injury and chronic kidney disease. Clinical and Experimental Pharmacology and Physiology. 2013;40(2):138-47. [Crossref]  [PMC]
  4. Tryggvason K, Wartiovaara J. How does the kidney filter plasma?. Physiology. 2005;20(2):96-101. [Crossref]  [PubMed]
  5. Harth O. The function of the kidneys. In Human Physiology. Berlin, Heidelberg: Springer Berlin Heidelberg. 1983:610-42. [Link]
  6. Pirlich M, Selberg O, Boker K, Schwarze M, Muller MJ. The creatinine approach to estimate skeletal muscle mass in patients with cirrhosis. Hepatology. 1996;24(6):1422-27. [Crossref]  [PubMed]
  7. Mahmood R, Batool M, Majeed N, Shoukat, Z, Qureshi AM, Shoaib M. Blood Urea Nitrogen (BUN) levels in renal failure: Unraveling the complex interplay of protein metabolism and kidney health. The Professional Medical Journal. 2024;31(03):364-70. [Crossref]
  8. Vassalotti JA, Centor R, Turner BJ, Greer RC, Choi M, Sequist TD, & National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Practical approach to detection and management of chronic kidney disease for the primary care clinician. The American journal of medicine. 2016;129(2):153-62. [Crossref]  [PubMed]
  9. Ricci Z, Cruz DN, Ronco C. Classification and staging of acute kidney injury: beyond the RIFLE and AKIN criteria. Nature Reviews Nephrology. 2011;7(4):201-08. [Crossref]
  10. Stevens LA, Levey AS. Measurement of kidney function. Medical Clinics. 2005;89(3):457-73. [Crossref]  [PubMed]
  11. Mercatello A. Changes in renal function induced by anesthesia. In Annales francaises d'anesthesie et de reanimation. 1990 January; Vol. 9, No. 6:507-24. [Crossref]  [PubMed]
  12. Anders MW. Formation and toxicity of anesthetic degradation products. Annu. Rev. Pharmacol. Toxicol. . 2005;45(1):147-76. [Crossref]  [PubMed]
  13. Burton D, Nicholson G, Hall G. Endocrine and metabolic response to surgery. Continuing Education in Anaesthesia, Critical Care & Pain. 2004;4(5):144-47. [Crossref]
  14. Barbani F, Angeli E, De Gaudio AR. Intravenous sedatives and analgesics. Critical care sedation. 2018:69-101. [Crossref]
  15. Wagener G, Brentjens TE. Anesthetic concerns in patients presenting with renal failure. Anesthesiology clinics. 2010;28(1):39-54. [Crossref]  [PubMed]
  16. Alizadeh R, Fard ZA. Renal effects of general anesthesia from old to recent studies. Journal of cellular physiology. 2019;234(10):16944-952. [Crossref]  [PubMed]
  17. Sołtysik A, Graczyk M, Woroń J. Use of opioid analgesics in chronic kidney disease. Palliative Medicine in Practice. 2022;16(3):156-66. [Crossref]
  18. Smith HS. The metabolism of opioid agents and the clinical impact of their active metabolites. The Clinical journal of pain. 2011;27(9):824-38. [Crossref]  [PubMed]
  19. Clarke KW. Desflurane and sevoflurane: new volatile anesthetic agents. Veterinary clinics of North America: Small animal practice. 1999;29(3):793-810. [Crossref]  [PubMed]
  20. Kharasch ED, Frink Jr EJ, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesthesia & Analgesia. 2001;93(6):1511-520. [Link] ://journals.lww.com/anesthesia-analgesia/fulltext/2001/12000/ [Crossref]  [PubMed]
  21. Leone A, Moncada S, Vallance P, Calver A, Collier J. Accumulation of an endogenous inhibitor of nitric oxide synthesis in chronic renal failure. The Lancet. 1992;339(8793):572-75. [Crossref]  [PubMed]
  22. Stollings JL, Diedrich DA, Oyen LJ, Brown DR. Rapid-se-quence intubation: a review of the process and considerations when choosing medications. Annals of Pharmacotherapy. 2014;48(1):62-76. [Crossref]
  23. Alizadeh R, Fard ZA. Renal effects of general anesthesia from old to recent studies. Journal of cellular physiology. 2019;234(10):16944-952. [Crossref]  [PubMed]
  24. Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M. Beginning and Ending Supportive Therapy for the Kidney (BEST Kidney) Investigators. Diuretics and mortality in acute renal failure. Critical care medicine. 2004;32(8):1669-77. [Crossref]  [PubMed]
  25. Meistelman C. Neuromuscular Blocking Drugs: Physiology, Pharmacology and Clinical Aspects. Total Intravenous Anesthesia and Target Controlled Infusions: A Comprehensive Global Anthology. 2017:267-97. [Crossref]
  26. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, ADQI workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Criticalcare. 2004:8,1-9. [Crossref]  [PubMed]  [PMC]
  27. Lambie M, Davies S. An update on absolute and relative indications for dialysis treatment modalities. Clinical kidney journal. 2023;16-1:39-47. [Crossref]  [PMC]
  28. Craig RG, Hunter JM. Recent developments in the perioperative management of adult patients with chronic kidney disease. British journal of anaesthesia. 2008;101(3):296-310. [Crossref]  [PubMed]
  29. Rang ST, West NL, Howard J, Cousins J. Anaesthesia for chronic renal disease and renal transplantation. eau-ebu update series. 2006;4(6):246-56. [Crossref]
  30. Cousins J, Howard J, Borra P. Principles of anaesthesia in urological surgery. BJU international. 2005;96(2):223-29. [Crossref]  [PubMed]
  31. Maiellare F, Sbaraglia F, Della Sala F, Garra R, Spinazzola G, Spanò MM, Rossi M. National Congress. Minerva Anestesiol. 2006;72(9):689-722. [Link]
  32. Snyder GL, Greenberg S. Effect of anaesthetic technique and other perioperative factors on cancer recurrence. British journal of anaesthesia. 2010;105(2):106-15. [Crossref]  [PubMed]
  33. Soltanizadeh S, Degett TH, Gögenur I. Outcomes of cancer surgery after inhalational and intravenous anesthesia: a systematic review. Journal of clinical anesthesia. 2017;42:19-25. [Crossref]  [PubMed]
  34. Arain MR, Buggy DJ. Anaesthesia for cancer patients. Current Opinion in Anesthesiology. 2007;20(3):247-53. [Crossref]
  35. Chen K, Wang J, Dai J, Luo A, Tian Y, Guan Z, Wang X. Anesthetic management of radical nephrectomy in patients with renal cell carcinoma involving renal vein or inferior vena cava. Tumori Journal. 2019;105(5):411-16. [Crossref]
  36. Haberal M, Boyvat F, Akdur A, Kırnap M, Özçelik Ü. Surgical Complications After Kidney Transplantation. Experimental and clinical transplantation: official journal of the Middle East Society for Organ Transplantation. 2016;14(6):587-95. [PubMed]