Abstract
In Japan, renal transplantation in now performed in more than about 1, 000 patients per year. We describe our experience with general anesthesia in a patient who underwent orthognathic surgery after living-donor renal transplantation.
The patient was a 24-year-old man. He was scheduled to undergo orthognathic surgery of the maxilla and mandible under general anesthesia to correct upper and lower jaw deformities.
The patient had undergone renal transplantation with his father as a donor at the age of 12 years. He received an immunosuppressive drug and methylprednisolone preoperatively.
Hydrocortisone was administered intravenously before the induction of anesthesia and during the operation to provide a steroid cover. From the day after surgery, the patient received hydrocortisone intravenously and methylprednisolone orally. General anesthesia was induced by treatment with fentanyl, propofol, and vecuronium, and endotracheal intubation was performed. Anesthesia was maintained with nitrous oxide, oxygen, isoflurane, and fentanyl. A low dose of dopamine was used to maintain urinary flow intraoperatively. After extubation in the operating room, the patient was sedated with dexmedetomidine in the recovery room. Oral immunosuppressive therapy was resumed the day after the operation.
General anesthesia, surgery, and perioperative management were successfully completed in this patient because 1) immunosuppressive therapy was continued, 2) a steroid cover was provided and perioperative stress was reduced, and 3) management methods and drugs for anesthesia were carefully selected to protect kidney transplantation.
