Low-dose local anesthesia may be an alternative to general anesthesia for Alport syndrome patients undergoing a renal transplant, aiding in a faster recovery of renal function, according to a case study in Italy.
Despite improvements in outcomes for kidney disease patients receiving new organs, about 25% report delayed restoration of renal function and 10% experience cardiovascular complications.
Such complications are particularly problematic in Alport syndrome, a kidney disease usually requiring dialysis or a transplant. Due to elevated levels of calcium in Alport patients, anesthesia management is challenging because of the risk of heart problems.
“Renal transplantation is usually performed under general anesthesia that provides the adequate muscle relaxation and the necessary depth for the surgery,” the researchers wrote. “However, general anesthesia can impact hemodynamic and sympathetic activity, possibly affecting renal function.’’
Researchers reported the case of a 38-year-old-man with Alport syndrome undergoing a kidney transplant due to chronic renal failure.
Because the patient showed baseline lung disease and abnormalities in heart conduction, doctors used local anesthesia — low-dose anesthetic agents — during a surgery that lasted three hours.
Using low-dose local anesthesia with continuous epidural infusion, the patient had no cardiovascular complications during the operation, the study reported. Quick improvements in urine output, serum creatinine, and blood urea nitrogen levels, indicative of improved renal function, were also noted.
In terms of side effects, local anesthesia can be associated with the risk of coagulopathy, a bleeding disorder marked by a reduced ability of the blood to clot properly. But this is treatable, the researchers said.
“Concerns about the use of regional anesthesia in patients with chronic renal failure may include potential altered platelet function and residual effects of heparin given during dialysis, both possible contraindications to the technique,’’ they wrote. “However, these have been addressed in the literature since it was shown that regional anesthesia may be used safely even in severe coagulopathy.”