الفهرس 
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Abstract
This study was designed to evaluate the different anaesthetic modalities in uraemic children undergoing construction of arterio-venous fistula. Fourty children suffering from end stage renal failure and scheduled for radial arterio-venous fistula or brachio basilic fistula were the subject of this study.
Induction of anaesthesia was similar in all patients being performed by thiopentone sod. (3mg. Kg.-1) and suxamethonium (1 mg. Kg 1). According to maintenance of anaesthesia, they were classified into four groups, ten patients each. Anaesthesia was maintained in the first group by N2O: O2 (FiO2: 0.5) and halothane (0.2 – 0.5 %) being adjusted to keep the heart rate and arterial blood pressure within minimal fluctuations. Neuromuscular blockade was achieved by atracurium (0.5 mg. kg-1) and incremental doses of (0.1 mg. Kg.-1) were given when needed. In the patients of the second group, vecuronium in a dose of (0.1 mg. Kg-1) and incremental dose of (0.05 mg. Kg.-1) was used instead of atracurium. In the third group, anaesthesia was maintained by isoflurane & atracurium. In the fourth group isoflurane was the volatile anaesthetic agent used and vecuronium was utilized as the muscle relaxant.
Haemodynamic variables (heart rate and mean arterial blood pressure), arterial O2 saturation & end tidal carbon dioxide tension were recorded before induction of anaesthesia, intraoperatively every 15 min. and 15 min. post-operatively. Arterial blood gasometric changes (PaO2, PaCO2, PH & HCO3-), biochemical variables (Na+ and K+) and haematological variables (Hb & Hct values) were measured before induction of anaesthesia, intraoperatively and one hour after recovery.
In this study, the heart rate remained constant throughout the procedure in the four groups. Mean arterial blood pressure showed no significant changes between the 4 groups except in isoflurane-vecuronium group which showed significant decrease 45 & 60 minutes after induction. There were no significant changes in blood gasometric variables. As FiO2 increased intra-operatively, there were significant increase in PaO2 as compared with the basal reading. The basal bicarbonate values were significantly higher in the third & fourth groups. Haematological data were constant throughout the procedure. There were no significant changes in biochemical data. The clinical parameters for recovery showed delayed ability to maintain opening eyes, to cough, to protrude tongue, to maintain elevated head without support and ability of the patient for hand grip in patients received halothane - vecuronium. This is followed by groups received isoflurane - vecuronium and halothane - atracurium. The best recovery was in the group anaesthetized with isoflurane & atracurium.
We concluded that the more reliable anaesthetic combination for children with ch. R. F. is isoflurane and atracurium.