9.2 Anesthetic Approach to Pregnant Women
9.2.4 Pregnancy After Renal Transplantation
In reproductive age renal transplant patients, pregnancy rate is 2% [4, 27].
Pregnancies following renal transplantation, the risk of preterm delivery, premature rupture of membranes, spontaneous abortion, low birth weight, and IUGR are high.
Preoperative anesthetic evaluation is important in these cases. Due to the immu- nosuppressive drugs (prednisolone, azathioprine, cyclosporine) affecting the kidney and liver function, biochemical parameters should be evaluated carefully [18].
Asepsis is extreme in these immunosuppressed patients.
Additional corticosteroids should be administered to these pregnant women who are currently receiving corticosteroid therapy in the perioperative period.
As with other pregnancies, perioperative hypovolemia/hypotension should be avoided.
Nonsteroidal anti-inflammatory drugs should not be used for postoperative anal- gesia; instead, non-nephrotoxic simple analgesics such as paracetamol can be administered [12].
Key Learning Points
• Pregnancy leads to anatomical and physiological changes in the renal sys- tem most of which are reversible.
• During pregnancy, renal blood flow and GFR increase by approximately 50%. Serum creatinine and BUN levels are nearly 50% of a nonpregnant woman.
• If the serum creatinine level in the pregnancy is 0.8 mg/dl or BUN level is
≥16 mg/dl, or proteinuria is more than 300 mg/day, it is considered as abnormal.
• The management of anesthesia for the pregnancies with ARF is different from the pregnancies with CRF.
• Anesthetics drugs with short duration of action and metabolized indepen- dently from the kidney (atracurium/cisatracurium, remifentanil, etc.) should be preferred.
• Aspiration prophylaxis using H2 receptor blocker should be performed in patients with CRF.
• Neuraxial anesthesia is preferred if there is no coagulopathy, thrombocyto- penia, and platelet dysfunction.
• Central blocks should be avoided in patients with uremic cardiomyopathy.
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Anesthesia for Pregnant Patient with Psychiatric Disorders
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