Management strategy of anesthesia during recovery period after laparoscopic partial nephrectomy using renal artery cold perfusion
Ding Lingling1, 2, Zhong Hong2, Ma Xin3, Zhang Xu3, Wang Tao2
1 Department of Anesthesiology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100853, China; 2 Department of Anesthesia & Surgery Center; 3 Department of Urology, Chinese PLA General Hospital
Abstract：Objective: To investigate the effect of laparoscopic partial nephrectomy on the recovery period of anesthesia and the related anesthetic strategies. Methods: The clinical data of 40 patients with completely intraparenchymal tumors treated by renal artery perfusion and conventional warm ischemia laparoscopic partial nephrectomy were analyzed retrospectively. Forty cases of renal tumor were divided into cold perfusion group (group A) and warm ischemic group (group B) (n=20 each group). In group A Fogarty double lumen balloon catheter was placed before operation. The two groups received the same anesthesia induction and intraoperative medication. After surgery revealed renal tumors, patients in group A were treated with 4℃ 200 mL perfusion solution to cool the kidneys. After surgery revealed renal tumors, the renal arteries were occluded by blood vessel clamp in group B. The MAP, BIS and temperature were recorded at different time points. Temperature respiratory recovery time, consciousness recovery time, extubation time, Ramsay and postoperative sedation-agitation scale were compared between two groups. The changes of CR and eGFR were compared before and after the operation in two groups. Results: There was no statistically significant difference in MAP, HR and BIS between two groups at different time points. The temperature in group A was obviously decreased as compared with that in group B (P<0.05). The spontaneous breathing recovery time in group A was obviously prolonged as compared with that in group B (P<0.05). The fully awake time and the extubation time in group A were obviously prolonged as compared with those in group B (P<0.05). The Ramsay scores in group A were obviously increased as compared with those in group B (P<0.05). The sedation-agitation scale in group A was obviously increased as compared with that in group B (P<0.05). The changes of CR and eGFR before and after operation in group A were decreased as compared with those in group B. Conclusions: Renal artery cold perfusion is a new frontier surgery clinically. The clinical experience shows that the recovery of renal function in renal artery cold perfusion is better than in renal artery occlusion. The anesthesia doctors should understand the change of surgical procedures and strengthen management simultaneously in order to reduce the postoperative complications.
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