ISPUB.COM The Internet Journal of Anesthesiology Volume 13 Number 1 1 of 5 Sevoflurane Anaesthesia in a Patient with Renal Transplantation: Case Report and Literature Review A Eroglu, E Erturk, H Bostan Citation A Eroglu, E Erturk, H Bostan. Sevoflurane Anaesthesia in a Patient with Renal Transplantation: Case Report and Literature Review. The Internet Journal of Anesthesiology. 2006 Volume 13 Number 1. Abstract In this case report, we have presented our anaesthetic management in a patient undergoing urgent abdominal surgery who has undergone renal transplantation before, and has been in a chronic haemodialysis program two times a week. Anaesthesia was induced with sevoflurane in nitrous oxide-oxygen mixture via a mask and maintained with sevoflurane 1.5% in N2O:O2 (50%:50%). A bolus dose of atracurium 25 mg was administered intravenously and intubation was done. Standard monitoring consisted of an electrocardiogram, non-invasive arterial pressure and pulse oximetry. Serum creatinine, potassium, sodium and blood urea nitrogen levels and also creatinine clearance were measured preoperatively and in the first, second, third and seventh postoperative days. Surgical cholecystectomy was performed and the duration of anaesthesia was 60 minutes. We conclude that sevoflurane does not aggravate renal impairment in measured parameters (serum creatinine, blood urea nitrogen and creatinine clearense) of renal function and does not change the time for haemodialysis in the patient with renal insufficiency. INTRODUCTION In addition to care being shown in the selection of drugs and agents in anaesthesia in renal insufficiency cases that will not increase renal damage and whose degradation will be independent of the kidney, care must also be taken regarding such situations as hypoxia and ischaemia ( 1 ). Sevoflurane, an inhalation anaesthetic, is used in anaesthesia induction by mask due to such features as its pleasant smell, the way it does not cause irritation in the respiratory channels, and rapid induction ( 2 ). In this report we describe the anaesthesia method used in a case with a transplanted kidney, undergoing dialysis twice a week, taken for emergency acute abdominal surgery. CASE REPORT A 48-year-old male weighing 70 kg and 172 cm tall had received a right kidney transplant 11 years previously due to chronic renal insufficiency. Cyclosporin (Sandimmun, Novartis) 3 x 350 mg, mycophenolate mophetil (CellCept, Roche) 3 x 250 mg and prednisolone (Deltacortil, Pfizer) 1 x 5 mg were used for immunosuppressant treatment. The patient's kidney functions had followed a normal course until three months previously, when he presented to hospital with high fever and complaints of swelling in the hands and feet. In measured parameters serum creatinine was 7.1 dL -1 , BUN 64 mg dL -1 , and potassium 4.5 mmol mg dL -1 and the patient was admitted to hospital. Due to urinary excretion of 500 ml on the first day and a total of 700 ml on the second, high BUN and creatinine, a creatinine clearance level of 6 mL min -1 and hypervolemia, he was admitted to the dialysis program twice a week. On day 20 of hospitalization ultrasonography of the patient, who had pain in the upper right abdominal region, nausea and fever, was compatible with cholelithiasis. He was diagnosed with acute abdomen and taken for emergency surgery. Following routine monitoring (ECG, non-invasive blood pressures, peripheral oxygen saturation) sevoflurane induction by mask was performed while talking to the patient. Sevoflurane was commenced at 5% and the patient's respiration and sedation level were gradually reduced. Following muscle relaxation with atracurium 25 mg, intubation was performed. Anaesthetic maintenance was established with sevoflurane 1.5% and an oxygen/N2 (40%/60%) mixture. There was no evident intraoperative change in initial blood pressure values of 140/90 mmHg, pulse values of 84 beats min -1 , or oxygen saturation values of 96%, and these continued within normal levels. A total of