Remifentanyl Infusion Intraoperatively Decreased the Total Dose of Atracurium Required for Recipient in Renal Transplant Surgery

Abstract

ABSTRACT:BACKGROUND: Renal failure is a disease characterized by loss of renal function and it affects all body systems.Anasthesia for renal transplant recipient needs skill and care to manage the abnormal systemic presentation of patient.Anesthetic plan is affected by renal failure and effects appear by anesthetic drugs choices, doses, and combination. This Anasthetic plan also affected by the cause of renal failure, drugs therapy, dialysis, and duration of disease.OBJECTIVE:To assess the effect of remifentanyl infusion on total dose of atracurium required during renal transplant surgery.METHOD: Between 1stJanuary-2011 to 1st February-2013, in renal transplant center, medical city-Baghdad-Iraq, and hundred patients had renal transplant. All patients had received midazolam (0.05Mcg/kg), fentanyl (1Mcg/kg), propofol sleeping dose (1-1.5mg/kg) and atracurium (0.6mg/kg) then intubated.Fifty patients were maintained with isoflurane (0.5-1 MAC), boluses of atracurium. Other fifty had same maintenance with addition of remifentanyl infusion using infusion pump in dose of (0.05-0.1Mcg).RESULT: Group with remifentanyl needed less dose of atracurium than group without remifentanyl. Mean dose for group with remifentanyl was (1.255mg/kg) while for group without remifentanyl was (1.623mg/kg).Mean time for surgery in both groups was approximately equal, in group with remifentanyl time was (172.16min), and other group was (174.16min).CONCLUSION: Remifentanyl infusion decrease the dose of neuromuscular blocking agents required and may abolish it but blood pressure and pulse rate should monitored carefully.