Intra-arterial nitroglycerin for intra-operative arterial vasospasm during pediatric renal transplantation.

Autor: Penna FJ; Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Harvey E; Division of Nephrology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., John P; Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Armstrong D; Division of Radiology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Luginbuehl I; Division of Anesthesia, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Odeh RI; Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Alyami F; Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Koyle MA; Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada., Lorenzo AJ; Division of Paediatric Urology, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2016 May; Vol. 20 (3), pp. 463-6. Date of Electronic Publication: 2016 Feb 21.
DOI: 10.1111/petr.12688
Abstrakt: Intra-operative arterial vasospasm during pediatric renal transplantation is an urgent clinical situation resulting in end-organ ischemia, associated changes in parenchymal turgor and color, diminished flow on ultrasound, and if left untreated, allograft loss. We hypothesized that intra-operative intra-arterial injection of nitroglycerin would reverse vasospasm and improve renal perfusion. A three-yr-old girl with end-stage renal disease due to autosomal recessive polycystic kidney disease on peritoneal dialysis underwent deceased donor renal transplantation. After optimal immediate reperfusion and hemodynamic parameters, the kidney lost turgor and became mottled in appearance despite adequate hilar arterial and venous Doppler waveforms. Two aliquots of 40 μg (0.4 mL of a 100 μg/mL) nitroglycerin solution were injected directly into the renal artery 10 min apart. Nitroglycerin resulted in dramatic change in the consistency and appearance of the allograft. An improvement in renal blood flow was demonstrated by ultrasound after the second intra-arterial nitroglycerin injection with only a transient decrease in systemic arterial blood pressure. The child experienced normal allograft perfusion on serial postoperative ultrasounds, with a prompt decrease in serum creatinine and excellent diuresis. Intra-arterial nitroglycerin is a promising option for intra-operative arterial vasospasm during pediatric renal transplantation with objective improvement in blood flow and perfusion.
(© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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