Renal Transplantation and End-Stage Renal Disease Anaesthesia — WACS Viva & Clinical Scenarios (Urology)

Exam-style renal transplantation and end-stage renal disease anaesthesia viva scenarios with examiner probes and model answers for ANAESTHESIA candidates.

Scenarios covered

• SCENARIO 1: A 38-year-old male with ESRD secondary to chronic glomerulonephritis is scheduled for a living-donor renal transplant from his brother. He completed haemodialysis 18 hours ago. Current blood pressure is 165/95 mmHg, haemoglobin 9.2 g/dL, serum potassium 4.9 mmol/L, serum creatinine 740 micromol/L. Outline your anaesthetic plan for induction, maintenance, fluid management, haemodynamic goals prior to and during clamp release, and protection of his left forearm AV fistula.
• SCENARIO 2: During renal transplantation in a 45-year-old recipient, upon unclamping of the external iliac vessels and graft reperfusion, the patient's blood pressure drops abruptly from 140/80 mmHg to 60/30 mmHg, accompanied by peaked T waves and broad QRS complexes on the ECG monitor. How do you immediately manage this acute declamping shock and reperfusion phenomenon?
• SCENARIO 3: A 32-year-old healthy female is undergoing laparoscopic living-donor nephrectomy. During pneumoperitoneum at 14 mmHg, urine output drops to <10 mL/hr over 2 hours despite normal blood pressure. How do you preserve renal blood flow and ensure donor safety and graft viability during the intraoperative period?
• SCENARIO 4: A 50-year-old diabetic patient with ESRD presents for creation of a left brachiocephalic AV fistula. He has severe peripheral vascular disease and cardiac autonomic neuropathy. Discuss the advantages and technique of regional anaesthesia versus general anaesthesia, and explain how regional blockade impacts fistula patency and blood flow.