RESUMO
Adults with congenital heart disease are increasing due to improvement in infant heart surgery and availability of better cardiac care. Pregnancy in these patients requires multidisciplinary team approach due to circulatory changes. We describe an anesthetic management of the parturient undergoing cesarean section having severe pulmonary restenosis.
RESUMO
Adequate intravascular volume maintenance is essential to ensure early graft function during renal transplantation. Various recommendations on optimum fluid therapy are based, at best, on sparse evidence, and that too only from observational studies. This prospective randomized controlled study was done to evaluate the effect of 20% human albumin on the early graft function in living donor renal transplantation. Eighty patients undergoing renal transplantation were randomly assigned to one of the intraoperative fluid regimens, 0.9% normal saline with 20% human albumin (albumin group) or 0.9% normal saline alone (saline group), after confirming the exclusion criteria. Intravenous fluid infusion was given to keep central venous pressure (CVP) between 12 to 15 mm Hg. The statistical package of social sciences, SPSS version 12, was used for statistical analysis. The intraoperative fluid volume infused [albumin group--3381±1021.2 vs. saline group--3487±978.5 (mL)] to maintain target CVP was comparable between the two groups (P value>0.05). Statistically, no significant difference was found between the two groups in terms of post transplant serum creatinine [day one; 2.76±1.0 vs. 2.58±0.94, day three; 1.48±0.53 vs. 1.43±0.71, day seven; 1.42±0.6 vs. 1.42±0.53 (mg/dL)] and urine output [day one; 13122.5±5767.8 vs. 13909.4±5324.7, day three; 9233.9±3267.4 vs. 9250±4794.2, day seven; 7517.6±3043.6 vs. 6921.4±3170 (mL)] (P value>0.05). Postoperative change in body weight [1.89±3.82 vs. 2.48±3.89 (kg)], tissue edema (10% vs. 7.5%), and pulmonary edema (2.5% vs. 5%) did not differ significantly (P>0.05). Twenty percent human albumin given intraoperatively, as a volume expander, does not improve early graft function in living donor renal transplantation. It should be used selectively rather than as a routine protocol.