A n a e s t h e s i a a n d Adequate fl uid loading before p e installation of Pneumoperithoneum, r i - together with prevention of blood o Anaesthesia and p e pooling with anti-thrombosis stockings r a and adjustment of the position, tiv peri-operative Care for e adequate ventilation with the aim C a to minimize elevated intrathoracic r e Laparoscopic Donor pressures, high dose of sufentanil and f o r adequate depth of anaesthesia results L a in the prevention of the hemodynamic p Nephrectomy a and renal compromise encountered r o s due to elevated intra-abdominal c o pressure, during laparoscopic donor p i c nephrectomy. D o Moreover, the differences in stress n o response between open donor r N nephrectomy and laparoscopic donor e p h nephrectomy have disappeared with r e this regimen. The use of propofol c t o anaesthesia and the addition of m y epidural analgesia further reduced the stress response and provided a faster and qualitatively better direct postoperative recovery. I In conclusion, the work presented in n g r this thesis shows that the anaesthetist i d is able to improve the outcome for the M e donor patient, as well as for the donor rt Ingrid Mertens zur Borg e kidney. n s z u r B o r g Anaesthesia and peri-operative Care for Laparoscopic Donor Nephrectomy Ingrid Mertens zur Borg The studies described in this thesis were performed at the Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands. Financial support for printing and celebration of this thesis was obtained from: — De Nederlandse Nierstichting — Arrow Nederland — Ministerie van Defensie — Stryker Nederland BV — KCI Medical BV — Fresenius Kabi Aquarel by Oscar van der Linden Layout, cover design and printing by HollandsGras Advies Ontwerp Realisatie Utrecht, the Netherlands www.hollandsgras.nl ISBN; 90-809069-1-3 ©2008, Copyright by Ingrid R.A.M. Mertens zur Borg Anaesthesia and peri-operative Care for Laparoscopic Donor Nephrectomy Anesthesie en peri-operatieve zorg voor laparoscopische donor nefrectomie Proefschrift ter verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam, op gezag van de rector magnificus Prof.dr. S.W.J. Lamberts en volgens besluit van het College voor Promoties. De openbare verdediging zal plaatsvinden op woensdag 28 mei 2008 om 11.45 uur door Ingrid Roos Agnes Maria Mertens zur Borg geboren te Nijmegen Promotiecommissie: Promotoren : Prof.dr. J. Klein Prof.dr. J.N.M. IJzermans Overige leden : Dr. T. van Gelder Prof.dr. D. Poldermans Prof.dr. G.J. Scheffer Copromotor : Dr. D. Gommers Contents 1 Introduction 11 Original studies 2 The effect of laparoscopic and open donor nephrectomy on the long term renal function in donor and recipient: a retrospective study Transplantation 2005 25 3 Comparison of three perioperative fluid regimens for laparoscopic donor nephrectomy: a dose finding study Surg. Endosc 2007 33 4 Effect of intra-abdominal pressure elevation and positioning on hemodynamic responses during carbon dioxide pneumoperitoneum for laparoscopic donor nephrectomy: a prospective controlled clinical study Surg. Endosc 2004 45 5 Beneficial effects of a new fluid regime on kidney function of donor and recipient during laparoscopic versus open donor nephrectomy Endourology 2007 55 6 Neuroendocrine stress response in laparoscopic and open donor nephrectomy are equal: propofol ensures more stress response reduction than isoflurane: a randomized controlled clinical study Submitted 67 7 Epidural anaesthesia for laparoscopic donor nephrectomy is beneficial for the donor without affecting kidney function: a randomized controlled clinical study Submitted 79 8 Effect of epidural analgesia on inflammatory and stress response in laparoscopic donor nephrectomy: a randomized controlled clinical study Submitted 93 9 Summary in English, samenvatting in het Nederlands 107 10 General discussion, conclusions and future perspectives 113 Appendices Abbreviations Contributing Authors Acknowledgements, Dankwoord Nawoord List of publications Curriculum Vitae Een leven in geschonken tijd André Bek Voor mijn ouders, Karel, Roos, Jan, Suske, Ben en mijn dierbare vrienden CHAPTER CHAPTER 3 1 CHAPTER 4 Introduction