| Abstrakt: |
INTRODUCTION: Renal transplantation is the most successful of all organ transplant surgeries. End stage renal disease (ESRD) is a complex disorder with multisystem involvement-each system disorder highlighting in every other patient with individualised needs. Poor fluid handling could present as fluid accumulation in every potential space / every areolar tissue to express as effusion and edema. IgA nephropathy, diabetic and/or hypertensive nephropathy have been attributed as the common causes of ESRD. An early and profuse albuminuria presented as progressive ascites as a predominant feature. High solute load of urea caused changes in pleura and pericardium to alter their membrane permeability to pleural and pericardial effusions. Uremic toxins, platelet dysfunction and hemolysis led to anemia centering or poor erythropoietin production by the juxta glomerular apparatus of the kidney. AIMS AND OBJECTIVES This study aims to analyse anaemia, pulmonary hypertension, Left ventricular dysfunction and fluid accumulation by clinical and laboratory parameters and establish interrelationship between the above challenges. By conducting this study we can list out anaesthetic challenges encountered during induction of general anaesthesia. And it can be used for offering reconditions for anticipated problems. METHODOLOGY: This is a retrospective study where 107 patients who have undergone renal transplantation since 2015. The parameters are used for this study are Hemoglobin, Edema, ascites, right ventricular systolic pressure (RVSP), ejection fraction(EF) and blood pressure. RESULT: Retrospective analysis of the data showed severity of anemia to proportional to pulmonary hypertension measured non-invasively by right ventricular systolic pressure.(P=0.038). The ejection fraction and blood pressure had negative correlation that is unique to ESRD. This is well observed in our analysis. The parameter denoting the above 3 observations namely, hemoglobin, mean arterial pressure, ejection fraction and right ventricular systolic pressure were noted along with presence of ascites and / or effusions. A rapidly accumulating ascites or pleural needs aspiration to prevent organ distortion fluid and collapse of lungs. The right ventricle and the left work as separate compartments. Hence a high BP exists with poor ejection fractions. Such patients are highly sensitive to vasodilators and an acute fall may jeopardise renal graft perfusion. A moderate or severe pulmonary hypertension is often associated with haemoglobin of less than 7g% as the basic pathology is endothelial dysfunction. While improvement in haemoglobin necessitates packed cell transfusion, an RVSP of more than 50mmhg may point towards a need for elective post-operative ventilation following the transplant. CONCLUSION: Though at undergraduate level concepts of pedal edema, hypertension, low blood pressure in poor left ventricular systolic function, ideal Mean Arterial Pressure, are drilled into - there may be contrasing findings in ESRD due to endothelial dysfunction leading to increasing vascular resistance. The key to effective management lies in individualisation of every patient, proper analysis and strategy formation. [ABSTRACT FROM AUTHOR] |
