Hypotension During Kidney Transplantation?
During live-related kidney transplantation, if the blood pressure falls after revascularization, how significant is this? Does it affect the outcome? Up to what level of hypotension can occur without problems? Do the antihypertensives given on the morning of surgery contribute? How do you treat it -- with ephedrine or with another inotrope?

Unnikrishnan Chundiran, MD

During implantation of the kidney, we ask the anesthesiologists to give furosemide (Lasix) 1 mg/kg and mannitol 1 g/kg over 45-50 minutes, and aim for a systolic blood pressure level of 140 mm Hg at the time of cross-clamp release. If the blood pressure is low after revascularization and there is no bleeding, a combination of volume, less anesthesia, and occasionally low-dose dopamine can be used to raise the blood pressure. Usually, the postoperative problem is rebound hypertension because the preoperative antihypertensive medications have been held.