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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES ANESTHESIOLOGY
Minerva Anestesiologica 2003 September;69(9):681-9
language: English, Italian
Perioperative management for laparoscopic kidney donation
Biancofiore G. 1, Amorose G. 1, Lugli D. 1, Bindi L. 1, Esposito M. 1, Fossati N. 1, Meacci L. 1, Pasquini C. 1, Pieri M. 1, Boggi U. 2, Pietrabissa A. 2, Mosca F. 2
1 Postsurgical and Transplant ICU Department of Anaesthesia and Intensive Care Cisanello Hospital, Pisa, Italy
2 Department of General and Transplantation Surgery, University of Pisa, School of Medicine Cisanello Hospital, Pisa, Italy
Aim. To report a single centre’s experience in the perioperative management of live kidney laparoscopic donations.
Methods. Design: comparative analysis of all laparoscopic kidney donations performed between April 2000 and August 2002 and a corresponding number of “traditional surgery” donors from a historical series. Setting: kidney transplant centre of a teaching hospital. Interventions: 39 and 27 subjects undergoing respectively laparoscopic and traditional “open” kidney donation were studied. A standard balanced anesthesiological technique was used in both groups but, to counterbalance the reported abdominal insufflation-related kidney dysfunction, laparoscopic donors were administered an extra intravascular volume loading with colloids and crystalloids starting from the night before surgery.
Results. Laparoscopic donors underwent a longer procedure with a lower estimated blood loss (p=0.0001) and were intraoperatively administered with a higher amount of intravenous fluids (p<0.01); they showed less postoperative analgesic requirement (p<0.0001), a shorter ICU stay and overall hospitalisation (p<0.001), a quicker resumption of solid oral intakes (p<0.01) and full return to work (p<0.001) with no difference in the rate of postoperative complications. Diuresis resumed intraoperatively in all recipients and early graft function did not differ in the 2 groups although serum creatinine declined earlier, but not significantly, in those receiving kidneys by the traditional method.
Conclusion. Kidney laparoscopic donation does not require a particularly complex or expensive anaesthetic management or approach; it is advisable to adopt strategies to counterbalance laparoscopy-associated abdominal hypertension.