الفهرس 
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Abstract
Summary
The appropriate anesthesia for renal transplantation requires minimal toxicity for the patients and for the transplanted organ, as well as sufficient pain relief and maintenance of vital functions.
General anesthesia is the most popular technique for renal transplantation. The use of regional anesthesia in chronic renal failure patients is still controversial but promising. With shorter operative times, renal transplants can be performed by using continuous epidural anesthesia. Continuous epidural anesthesia has been used since 1990 in renal transplant surgery.
Some clinical studies suggest that postoperative morbidity and possibly mortality may be reduced when neuroaxial blockade is used either alone or in combination with general anesthesia in some settings.
Due to the advantages of epidural anesthesia in improving tissue blood flow and decreasing the surgical inflammatory response, we supposed that epidural anesthesia can be used as an important alternative to general anesthesia during renal transplantation surgery in adult patients without adverse effects on graft function and may impose a positive outcome.
The aim of the current study is to determine how the anesthetic technique influences the outcome in patients; early after renal transplantation in terms of; intraoperative hemodynamic changes, blood gas changes, and early postoperative renal allograft function.
The study was done at Kasr-El-Ainy Hospital, Faculty of Medicine, Cairo University in King Fahd Unit after approval of the local ethical committee, adequate preoperative evaluation, and after obtaining of a written informed consent from all patients enrolled in the study;
This study was conducted on fourty (40) adult patients who underwent renal transplantation. The fourty patients were divided into two groups, of twenty (20) patients each: in one group, epidural anesthesia was applied and in the other group, general anesthesia was conducted.
Intraoperative monitoring and recording of hemodynamic and biochemical data was done. Recording of UOP and fluid requirement at the end of surgery was done.
In epidural group, epidural analgesia was continued for three days post-transplantation while in general group parentral opioids were used.
Postoperative monitoring of hemodynamics and recording of biochemical data and UOP was done. Creatinine reduction ratio at day 2 post-transplant (CRR2%) was calculated. Doppler ultrasonography third day post-operative was used to measure the resistance in renal graft vessels.
Statistical analysis was done to compare the postoperative renal function in the two groups.
Results from the present study imply that; the use of epidural anesthesia is associated with improved early graft function in renal transplantation compared with general anesthesia in adult patients.
It is of great value to remember that; our results were based on data obtained after short follow up period which was three days post-transplantation, more researches are needed with longer follow up periods to detect the impact of anesthetic technique not only on early renal graft function but also on graft survival, morbidity and mortality.