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Canadian Journal of Anesthesia, Vol 30, 587-592, Copyright © 1983 by Canadian Anesthesiologists' Society

Level of Consciousness After Cadaveric Kidney Transplant Under Halothane Anaesthesia

PIERRE A. CASTHELY MD1 and RAYMOND VILLANUEVA MD1

1 Department of Anesthesiology, State University of New York, Downstate School of Medicine, Brooklyn, New York

Address correspondence to: Pierre A. Casthely MD, Department of Anesthesiology, Downstate Medical Center, 450 Clarkson Avenue, Box 6, Brooklyn, New York 11203

Serum and urine bromide levels, serum morphine levels, and postoperative awakening times were observed in 24 patients; 16 undergoing cadaveric kidney transplantation under halothane anaesthesia, eight without preanaesthetic medication (Group A) and eight with morphine preanaesthetic medication (Group B), and eight patients (control) with normal kidney function scheduled for colon resection (Group C). Bromide levels were higher in patients after kidney transplant than in the control group. Transplant patients who did not receive morphine awakened faster after anaesthesia than patients who received 10 mg of morphine 60 minutes before anaesthesia. Morphine levels at the end of anaesthesia were 145 µg·100 ml-1 in Group B; significantly higher than those found in patients with normal kidney function (Group C) (5 ± 1.05). The majority of the patients undergoing kidney transplantation and receiving morphine for premedication were fully awake 24 hours following surgery espite serum bromide levels of 158 µg·ml-1. Control patients had higher awakening scores after surgery than patients in Group A, despite receiving 10 mg of morphine aspreoperative medication.

Serum bromide levels were far below 480 µg·ml-1, the level required to produce clinical symptoms of bromism. The serum and urine bromide levels found in the patients after kidney transplant, even when higher than the control group, were not high enough to explain the prolonged sleepiness found in these patients. The morphine given as preoperative medication may be one of the factors responsible for this finding. Other factors, such as decreased protein binding, decreased albumin levels, abnormal blood brain barrier and brain function, and the degree of function of the transplanted kidney may account for the prolonged sleepiness found in patients receiving transplants.

Key Words: ANAESTHETICS, VOLATILE: halothane • ANAESTHETICS, NARCOTIC: morphine • METABOLISM: halothane, bromide






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Copyright © 1983 by the Canadian Anesthesiologists' Society.