Operative Preparation Patient Preparation

Surgery is performed with the donor under general endotracheal anesthesia. Sequential compression stockings are placed on the lower extremities. After induction of anesthesia, an oral gastric tube is placed to decompress the stomach, and a Foley catheter is placed to decompress the bladder. One dose of intravenous antibiotics is administered. The urine collection bag is placed near the anesthesiologist to closely monitor intraoperative urine output.

Pneumoperitoneum decreases renal blood flow; so vigorous intravenous hydration is necessary to maintain urine output (19). Patients should receive 1 to 2 L of intravenous fluid prior to insufflation of the abdomen, and typically receive 5 to 6 L of crystalloid during a routine procedure. The first dose of intravenous mannitol (12.5 g) is given after the second liter of fluid is infused.

The anesthesiologist should be instructed to maintain a urine output of 100 cc/hr. This will keep the potential allograft well hydrated and will keep the renal vein appearing full and make it easier to identify during the dissection.

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