Comparison Of Three Anaesthesia Methods For Homogeneity Variant Renal Transplantation

Objectives: To compare the advantage and disadvantage among epidural anaesthesia, general anaesthesia and combined spinal epidural anaesthesia methods for homogeneity variant renal transplantation.Methods: 1051 cases undergoing homogeneity variant renal transplant tation from 1997 to 2007 in Shenyang Military Command General Hospital were retrospectively analyzed. 2 cases received epidural anaesthesia and 12 cases received combined spinal epidural anaesthesia were excluded for beingtionaltered to general anaesthesia.The others 507 cases were classified three groups by anaesthesia mode: 26 cases received epidural anaesthesia were group EA, 104 cases received general anaesthesia were group GA, 377 cases received combined spinal epidural anaesthesia were group CSEA.We recorded haemodynamic parameters (8 time-points: T1 before operation, T2 5min after the first injecting local anaesthetics , T3 10min after the first injecting local anaesthetics, T4 operation begin, T5 block circulation, T6 open circulation, T7 operation end. T8 10min after operation), anaesthetic effect(expressed by doses of local anaesthetics, proportion of using analgesics, sedatives and dopamine, the time of anaesthesia reaction and anaesthetic plane), anaesthetic negative response, the time of uropoiesis, PCEA and the survival rate of graft among one year. SPSS13.0 software was used as statistical method. Normally measurement data were expressed as mean±standard and compared with two-sample t-test or one-way ANOVA. Proportion and rate were expressed as persent and compared with Chi-square. Results:1. No significant difference was found among demographic data and length of surgery.2. Haemodynamic parameters: Variance rate of MAP: Group EA was less than the others at the point of T2; group CSEA was less than the group GA at the point of T7 and T8(P<0.01). Variance rate of HR: Group EA was higher than the group CSEA at the point of T6; group GA was obviously higher than the others at the points of T8(P<0.01). SpO2: Group GA was remarkably the others at points of T2~T8(P<0.01);group CSEA was higher than group EA at points of T3 and T6(P<0.05).3. Anaesthetic effect: Obvious statistically differences were found for doses of local anaesthetics, proportion of using narcotics and sedatives, the time of anaesthesia reaction and anaesthetic plane in group CSEA and group EA(P<0.01). No statistically differences were found for proportion of dopamine in group CSEA and group EA(P>0.05).4. Anaesthetic negative response: No statistically differences were found for the rate of cardiac failure, lung edema and head pain in three groups after operation. 4 cases in group CSEA occurred epidural bleeding and 1.06%. 16 cases in group GA had delayed awakening after operation and 15.5%. Obvious statistically differences were found for the rate of nausea and systemic toxicity during operation in group CSEA and group EA. Obvious statistically differences were found for the rate of systemic toxicity and respiratory infection after operation in three groups. Group GA was obviously higher than the others groups.5. The three groups were different in time of uropoiesis. Group CSEA was less than the others(P<0.01).6. PCEA and the survival rate of graft among one year: Group CSEA and EA have PCEA. Group GA have no one PCEA. Group CSEA was obviously higher than the others groups about of the survival rate of graft among one year.Conclusion:1. The anaesthetic effect of EA is below(the time of anaesthesia reaction is long, the anaesthetic plane is low ,the doses of local anaesthetics are large, the proportion of using analgesics and the sedatives is higher), the rate of toxic reaction of local anaesthetics is higher. Now the EA is slightly used in clincal.2. The anaesthetic effect of GA is better.The indications are wide and the DO2 is sufficient. But the haemodynamic of peroperation is stable, it has delayed awaken after operation and respiratory infection.So it is less used.3. The anaesthetic effect of CSEA is good(the time of anaesthesia reaction is short, the anaesthetic plane is higher and the doses of local anaesthetics are small),the rate of anaesthetic negative response is low. The use of PCEA in CSEA are possible. So it is a suitable anaesthesia method for homogeneity variant renal transplantation comparing with EA and GA.