Perioperative anesthesia care for the pediatric patient undergoing a kidney transplantation: An educational review

Figures

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  FIGURE 1. Factors contributing to kidney oxygen delivery and oxygen consumption in kidney transplantation. Oxygen delivery to the kidney is the product of renal blood flow and arterial oxygen content. Arterial oxygen content depends on hemoglobin concentration and arterial oxygen saturation. Renal blood flow is the resultant form cardiac output, intravascular volume, renal artery patency and autoregulation of renal perfusion pressure. When intact, intrarenal autoregulatory mechanisms regulate blood flow and pressure at the glomerulus, within a defined range of arterial blood pressure. Microvascular function, oxygen diffusion gradient and tissue properties play important roles in medullary tissue oxygenation. After kidney ischemia and reperfusion, oxygenation may be hampered due to edema and endothelial damage. Oxygen consumption is mainly determined by basic renal cell metabolism, glomerular filtration rate and sodium reabsorption. The medulla's microvascular structure and high oxygen consumption rate make this region more prone for a disbalance between oxygen delivery and oxygen consumption. Therefore, it is more affected by hypotension and hypoxia compared with the renal cortex

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  FIGURE 2. Algorithm of perioperative hemodynamic therapy in pediatric kidney transplantation guided by blood pressure and cardiac output measurements. NaHCO3 = sodium bicarbonate; MAP = Mean Arterial Pressure; CO = cardiac output; CI = Cardiac Index. Fluid responsiveness is defined as an increase in CO (or stroke volume) of >10%. *Consider using balanced solution (like lactated Ringers’ solution) to prevent hyperchloremic acidosis