Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study

Vinod Kumar; Virendra Kumar Arya; Rakesh V. Sondekoppam; Suman Arora; Mukut Minz; Rakesh Garg; Nishkarsh Gupta

doi:10.4103/0019-5049.199853

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Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study

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Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study

Vinod Kumar, Virendra Kumar Arya, Rakesh V. Sondekoppam, Suman Arora, Mukut Minz, Rakesh Garg and Nishkarsh Gupta

Indian journal of anaesthesia, Vol.61(2), pp.150-156

02/01/2017

DOI: 10.4103/0019-5049.199853

PMCID: PMC5330072

PMID: 28250484

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Abstract

Background and Aims: Antihypertensive drugs are continued until the day of renal transplant surgery. These are associated with increased incidence of hypotension and bradycardia. Hence, this study was designed to evaluate perioperative haemodynamic and early graft functioning in renal recipients with discontinuation of antihypertensive drugs on the morning of surgery. Methods: This prospective, randomised, double-blind study recruited 120 patients. Group 1 patients received placebo tablet while Group 2 patients received usual antihypertensive drugs on the day of surgery. Perioperative haemodynamics and time for reinstitution of antihypertensives were the primary outcome measures. The secondary outcome measures were need for inotropic support and graft function. Perioperative haemodynamics were analysed using ANOVA and Student's t-tests with Bonferroni correction. Fischer's exact test was used for analysis. Results: Systolic blood pressure (SBP) declined, which was more in Group 2. Forty-one patients developed significant hypotension; a correlation was found between the maximum observed hypotension and number of antihypertensive medications (P = 0.003). Four cases had slow graft function (one in Group 1 and three in Group 2). Twenty-eight patients in Group 2 required mephentermine boluses to maintain their SBP compared to 13 patients in Group 1 (P < 0.001). Two patients in Group 2 required dopamine to maintain SBP above 90 mmHg after the establishment of reperfusion as compared to none in Group 1. Conclusion: Single dose of long-acting antihypertensive drugs can be omitted on the morning of surgery without any haemodynamic fluctuations and graft function in controlled hypertensive end-stage renal disease renal transplant patients receiving a combined epidural and general anaesthesia.

Anesthesiology

Life Sciences & Biomedicine

Science & Technology

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Title: Subtitle: Effect of discontinuing morning dose of antihypertensive for renal transplant surgery on haemodynamic and early graft functioning: A prospective, double-blind, randomised study
Creators: Vinod Kumar - AIIMS, New Delhi
Virendra Kumar Arya - Post Graduate Institute of Medical Education and Research
Rakesh V. Sondekoppam - Post Graduate Institute of Medical Education and Research
Suman Arora - Post Graduate Institute of Medical Education and Research
Mukut Minz - Post Graduate Institute of Medical Education and Research
Rakesh Garg - AIIMS, New Delhi
Nishkarsh Gupta - AIIMS, New Delhi
Resource Type: Journal article
Publication Details: Indian journal of anaesthesia, Vol.61(2), pp.150-156
DOI: 10.4103/0019-5049.199853
PMID: 28250484
PMCID: PMC5330072
NLM abbreviation: Indian J Anaesth
ISSN: 0019-5049
eISSN: 0976-2817
Publisher: MEDKNOW PUBLICATIONS & MEDIA PVT LTD
Number of pages: 7
Language: English
Date published: 02/01/2017
Academic Unit: Anesthesia
Record Identifier: 9984295955302771

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