Perioperative anesthetic management of the kidney-pancreas transplant recipient.

Patients undergoing simultaneous pancreas-kidney transplantation are at risk for a variety of serious perioperative complications. These are related to the chronic and acute problems associated with end-stage renal disease and insulin-dependent diabetes mellitus and the prolonged, vascular and ductal surgery required to implant the two allografts. A number of strategies need to be integrated and diligently implemented to minimize the physiologic perturbations and complications related to the recipient's comorbid conditions and revascularization of the allografts.

Fentanyl pharmacokinetics in patients undergoing renal transplantation.

Study Objective: To describe the pharmacokinetics of fentanyl in patients undergoing renal transplantation.

Design: Prospective.

Setting: A large university teaching hospital.

Effects of long-term drugs on alfentanil clearance in patients undergoing renal transplantation.

Although patients in renal failure frequently take several drugs on a long-term basis, drug-induced alterations in alfentanil metabolism have not been examined as a possible source of variability in alfentanil clearance in this population. We compared the pharmacokinetics of alfentanil during renal transplantation in seven patients receiving and six not receiving long-term drug therapy. After the rapid intravenous injection of alfentanil 100 micrograms/kg during isoflurane anesthesia, plasma concentrations were measured at intervals up to 6 hours by radioimmunoassay.