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.

Pharmacokinetics of fentanyl in neonates.

The pharmacokinetics of fentanyl were studied in fourteen neonates undergoing major surgical procedures. Five patients were less than 1 day of age, seven were 1-4 days old, and two were 7-14 days old. Fentanyl was given intravenously, 10 micrograms/kg (n = 1), 25 micrograms/kg (n = 4), or 50 micrograms/kg (n = 9), and plasma concentrations measured at intervals of up to 18 hr.

Dissimilarities between droperidol and phentolamine on vascular tone and dopamine and norepinephrine vasoconstriction.

Droperidol has been found to have an alpha-adrenoceptor blocking potency comparable to phentolamine in in vitro studies where norepinephrine was used as the alpha agonist. Because dopamine also stimulates alpha receptors, its vasoconstrictor effects should be similarly inhibited by droperidol and phentolamine. Because the aforementioned comparisons have not been examined in vivo, we continuously infused either droperidol or phentolamine into a denervated canine hindlimb, perfused at a constant rate of blood flow, and measured changes in the basal perfusion pressure and its response to intra-arterial injections of dopamine and norepinephrine.

Effects of pharmacologic alterations of adrenergic mechanisms by cocaine, tropolone, aminophylline, and ketamine on epinephrine-induced arrhythmias during halothane-nitrous oxide anesthesia.

The purpose of this study was to examine the effects of pharmacologic alterations of adrenergic terminating mechanisms by cocaine, tropolone, aminophylline, and ketamine on the ability of epinephrine to induce arrhythmias during halothane-nitrous oxide anesthesia in dogs. Because the first three drugs inhibit intraneuronal uptake of catecholamines, extraneuronal catechol-O-methyl transferase (COMT), and phosphodiesterase, respectively, they might be expected to potentiate epinephrine-induced arrhythmias. To evaluate this possibility, the authors devised a technique for determining the minimal arrhythmic dosage of epinephrine that permitted graded assessment of changes in the sensitivity of the heart to epinephrine-induced arrhythmias.