Kidney anaesthesia

Figure 9.2 Structural overview of a nephron, the functional unit of the kidney. This figure was published in Anaesthesia and Intensive Care Medicine, Voi. 6, B.J. Pieunqr, Modes of drug eiimination, pp. 277-279, Copyright Eisevier 2005.

These act almost instantaneously, i.e., within a few seconds after administration. Because of this peculiar characteristics they are usually employed to produce general anaesthesia and to control convulsions. They may be used either alone or in conjimction with inhalation anaesthesia. After administration, they are first deposited in adipose tissues but are eventually dependent on the liver and kidney for their ultimate metabolic degradation and elimination. 

To produce surgical anaesthesia, it has been seen that a plasma thiopental concentration of 39-42 pg/mL is necessary [78]. The average dose required for induction is essentially independent of age in patients between 20 and 60 years [59]. A reduction in dose may be required for patients over the age of 60 with severely deteriorated hepatic function, with moderately affected kidney function [59], or those heavily premedicated with narcotics and other central depressants [61]. 

A 20-month-old infant taking captopril was haemodynamically stable for 35 minutes after induction of anaesthesia while awaiting a donor kidney, but then developed hypotension after a holus dose of 20 mL of albumin 4% (Albumex) was given. This was reversed with dopamine infusion. ... 

The toxicity and metabolism of the fluorinated anaesthetics CF,-CHCIBr (Halothane), CFy-CHj-O-CHiCH, (Fluoroxene), and MeO CF,-CHCIj (Methoxyflurane) have been reviewed (P. H. Rosenberg and M. M. Airaksinen, Fluoride, 1973,6,41), and renal impairment linked with Methoxyflurane anaesthesia has been consider in a review concerning the effects of fluoride on the kidney (J. Jankauskas, Fluoride, 1974, 7, 93). Halothane and Fluoroxene anaesthesiology has been reviewed (S. H. Ngai, Handt. Exp. Pharmakol., 1972, 30, 33 L. E. Morris, ibid., p. 93). 

Fig. 314. Smooth endoplasmic reticulum in a proximal tubule cell. Kidney (block BNh 3384) from a male Wistar rat (No. 2568) 2 h after a single intraperitoneal injection of 5 mg N-benzhydryl-JV -p-hydroxybenzylpiperazine HCl per kg body weight. Under pentobarbital anaesthesia (30 mg/kg), the animal was perfused from the abdominal aorta with 2.5 % glutaraldehyde in 0.1 M sodium cacodylate buffer (pH 7.4). Postfixation with 1 % osmium tetroxide in sodium cacodylate buffer. Embedded in Epon 812 and sectioned at 50 nm. Lead citrate and uranyl acetate. Plate 2970...

Dahlgren, B. E. and Goodrich, B. H. (1976) Changes in kidney and iiver function after meth-oxyflurane (Penthrane) anaesthesia. Brit. J. Anaesth., 48, 145. 

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