1/5. propofol infusion for induction and maintenance of anaesthesia in patients with end-stage renal disease.We have investigated the pharmacokinetics and pharmacodynamics of propofol in 11 patients with end-stage renal disease (ESRD) compared with nine healthy patients during and after a manually controlled three-stage infusion of propofol 21, 12 and 6 mg kg-1 h-1 lasting a minimum of 2 h. Mean total body clearance was not reduced significantly in the ESRD group (30.66 (SD 8.47) ml kg-1 min-1) compared with the control group (33.75 (7.8) ml kg-1 min-1). ESRD patients exhibited a greater, but not statistically significant, volume of distribution at steady state compared with patients in the control group (11.25 (8.86) vs 5.79 (2.14) litre kg-1, respectively). Elimination half-life values were unchanged by renal failure. Mean times to induction of anaesthesia were similar in both groups: 177 (SD 57) and 167 (58) s for the ESRD and control groups, respectively. Waking time after cessation of propofol infusion was significantly shorter in the ESRD group (474 (156) s) compared with the control group (714 (240) s) (P < 0.05). Mean plasma concentrations on waking were similar. We conclude that the pharmacokinetic and pharmacodynamic profiles of propofol after infusion were not markedly affected by renal failure.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Extensive bleeding during surgical treatment for gingival overgrowth in a patient on haemodialysis--a case report and review of the literature.Before performing renal transplantation, a most important concern is to control any infection, including oral infections before transplantation. The bleeding diathesis of patients with uraemia is a significant clinical concern, especially when surgery is required. A 44-year-old female patient on haemodialysis was referred for evaluation of gingival overgrowth. The patient was planning a renal transplantation two months later. As the lesions were not considered successfully treatable before transplantation, a gingivectomy and teeth extraction was performed. In pre-operative examinations, an abnormal bleeding time was not detected and other coagulation tests were normal. Under general anaesthesia, 19 teeth were extracted and overgrown gingiva was removed. During the operation, extensive blood loss of 1650ml occurred and four units of concentrated red blood cells were transfused. This study suggests that patients with renal failure undergoing dental surgery require careful pre-surgical evaluation including assessment of their coagulation ability.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Recurrent bronchospasm during anaesthesia.Bronchospasm complicated several anaesthetics in a diabetic patient with chronic renal failure. The bronchospasm was accompanied frequently by bradycardia. The pathophysiology, treatment and implications for future anaesthetic management are discussed.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
4/5. heart surgery in patients under haemodialysis.Several cases of open-heart surgery on patients with severe chronic renal failure have been reported in the last few years. The present study reviews the main problems posed by this situation and analyses our recent experience of three successfully managed patients. Emphasis is made on preoperative preparation, drugs employed in anaesthesia, and postoperative management. We conclude that the prognosis of these patients is good, and that their management is quite similar to that of nephrologically healthy patients.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/5. Intraoperative QRS-interval changes caused by hyperkalaemia in an infant with Arima syndrome.A one-year-and-ten-months-old male infant with Arima syndrome, a very rare genetic disorder, underwent urgent insertion of a catheter for continuous ambulatory peritoneal dialysis (CAPD) under general anaesthesia. During the procedure he showed QRS-interval changes caused by hyperkalaemia which was successfully treated with calcium gluconate. The management and intraoperative complications of this syndrome are reported and available literature reviewed.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |