The role of the anaesthetist in the management of acute renal failure

Abstract

Summary: The problems encountered by the anaesthetist in the treatment of patients with acute renal failure are discussed. The diagnosis and initial treatment are reviewed, with special emphasis on the treatment of hyperkalaemia and overhydration. The treatment with mannitol in the early phase of uraemia is discussed. Uraemic patients can be safely transported over long distances provided a free airway, sufficient ventilation, a stable circulation and correction of hyperkalaemia are established. Cardiac arrest is common in patients with uraemia especially in connection with obstructive jaundice, hypoxaemia and electrolyte disturbances. The most common provocative cause of cardiac arrest is a vasovagal reflex elicited by endotracheal suction. Pulmonary complications leading to respiratory insufficiency are a major risk. Artificial ventilation should be instituted before the patient becomes exhausted, and before carbon dioxide tension rises above normal levels. The main points in the prevention of complications during and after anaesthesia are: early and active treatment of uraemia with dialysis, sufficient atropinization, the most meticulous avoidance of hypoxia and carbon dioxide retention, a careful replacement of any fluid loss and avoidance of overhydration. Postoperatively the patient must be under continuous observation until he is fully awake and the respiration is completely restored. © 1968 John Sherratt and Son Ltd.