Continuous Epidural Anesthesia for Living-related Renal Transplant in a Patient With Malignant Hyperthermia and Reduced Cardiac Function: A Case Report and Narrative Review of the Literature.

Kidney transplantation is most often performed under general anesthesia, with or without regional anesthesia for adjunctive pain control. Select patients may benefit from neuraxial anesthesia as their primary anesthetic, especially when their comorbidities preclude the safe provision of general anesthesia. In this report, we describe the case of a 75-year-old man with malignant hyperthermia and ischemic cardiomyopathy who underwent a living-related kidney transplant under epidural anesthesia. Intraoperative hemodynamics were stable, and pain control was excellent; the surgeon reported no difficulties during the procedure. Allograft function was immediate and robust, and postoperative pain was well-controlled. The patient denied any side effects from the epidural block. We then summarize relevant literature from the 1960s through the present time regarding neuraxial blocks as the primary anesthetic for kidney transplantation and address considerations around the performance of neuraxial anesthesia in patients with end-stage renal disease. We also discuss common hesitations with neuraxial anesthesia and summarize the available data on patient-centered outcomes. Neuraxial anesthesia affords benefits of similar hemodynamics, similar allograft function, and improved postoperative pain control for patients undergoing kidney transplantation, compared to general anesthesia. Spinal, epidural, or combined spinal-epidural techniques should be given consideration when designing an anesthetic for patients with certain comorbidities that heighten the risk of a general anesthetic.