Efficacy of combined general anesthesia with an epidural component in combined kidney and pancreas transplantation

Introduction. Simultaneous kidney and pancreatic transplantation (SKPT) is the most effective surgical method for the treatment of patients suffering from type 1 diabetes mellitus complicated by stage 5 chronic kidney disease. Given the high traumatic nature and duration of this surgery, it is necessary to achieve an optimal depth of anesthesia, a sufficient level of anesthetizing with minimal negative pharmacological effects of drugs on grafts. This study aimed at investigating the efficacy of anesthetic management when using combined general anesthesia with or without an epidural component in SKPT.

Objective. To compare the efficacy of providing anesthesia when using combined general anesthesia with an epidural component and without an epidural component in SKPT recipients.

Material and methods. A retrospective study was performed with the prospective control of 85 recipients who underwent SKPT at the N.V. Sklifosovsky Research Institute for Emergency Medicine in the period from 01/01/2008 to 12/31/2024. There were 52 men (61%) and 33 women (39%) among them, the median age was 35 (31;39) full years. The patients were divided into two groups: group I included patients who underwent surgery under general combined anesthesia with an epidural component of anesthetizing, group II included patients who underwent surgery under general combined anesthesia without an epidural component of anesthesia. Intraoperative hemodynamic parameters, acid-base state parameters and electrolytes at the main stages of surgery were analyzed; intraoperative consumption of basic anesthetic drugs, the frequency of extubation of patients in the operating room after surgery, the frequency of postoperative nausea and/or vomiting at the end of surgery were compared between the groups; recovery time was analyzed.

Results. In group I, there was a statistically significant decrease in the total amount of all major anesthetic drugs compared with group II (p<0.001). The rate of patient extubations in the operating room was 37.5%, making 72.2% in group I and being statistically significantly higher compared to 34.7% in group II (p<0.001). The total intraoperative volume of diuresis in patients of group I was 1.5 times higher than in group II, the difference being statistically significant (300 (175;500) ml versus 200 (100;300) ml, respectively) (p=0.029); the median time of intestinal motility recovery in the intensive care unit in group I was 22 (18;26) hours, which was 1.3 times shorter than 29 (26;34) hours in group II (p<0.001).

Conclusion. The use of the epidural component of anesthesia as part of general multicomponent anesthesia for SKPT can significantly reduce the amount anesthetic drugs to be administered. Intraoperative diuresis and the rate of operating room patient extubations after surgery increase statistically significantly, and the time of intestinal motility recovery in the early postoperative period is reduced.

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