ANASTHESIA FOR SIMULTANEOUS BILATERAL NEPHRECTOMY LEONArm

BILATERAL SIMULTANEOUS NEPHRECTOMY is a important surgical procedure prior to renal transplant. Any anaesthetist may be asked to anaesthetize for this operation, as these procedures may be carried out in centres other than those where the renal transplant may be performed at a later date The anaesthetic problems in bilateral nephrectomy are not unlike those associated with renal transplantation. Although the change to eadaveric donors has widened the scope of renal transplantation, there are advocates of a return to living donor transplants, on the basis that the risks involved in nephrectomy in a healthy adult are now so minimal that this approach is justified. 1 This places more emphasis on the necessity for a dea r understanding of the problems associated with simultaneous bilateral nephrectomy. Although undoubtedly the primary indication for simultaneous bilateral nephrectomy is to prepare for eadaveric renal transplantation, some authors have advocated this procedure for the control of malignant hypertension.-" Many authors have described the possible serious complications of standard anaesthetic techniques in uraemic patients. Complicated approaches to the problem have been suggested and several agents in common use have been condemned. The main controversy has centred around the use of muscle relaxants. However, improvement in the preparation of patients for renal transplantation by efficient haemodialysis and recent new knowledge of the pharmacology of muscle relaxants have rendered many of these arguments invalid. The common denominator in bilateral nephrectomy and kidney transplantation is terminal renal failure, which often is exacerbated by concomitant disease. Despite the fact that patients are nowadays much better prepared by haemodialysis, yet by the standards of normal anaesthetic practice they remain extremely poor risks. Nevertheless, the anaesthetic techniques usually employed for abdominal surgery, with specific consideration of the unique problems of these patients, have proved safe and effective. This paper describes 126 consecutive operations for simultaneous bilateral nephreetomy in preparation for cadaver transplantations. There were no deaths in this series.