Intra- and postoperative adverse events in children with nephrotic syndrome requiring surgery under general anesthesia

Background: There are few data regarding perioperative adverse events in children with nephrotic syndrome. Objectives: The aim of this study was to describe the nature and frequency of perioperative adverse events in children with nephrotic syndrome. Materials and Methods: This is a retrospective study from a large university pediatric hospital. All procedures under general anesthesia in children with nephrotic syndrome between January 1995 and May 2007 were included, with the exception of renal transplantation. Data were collected on demographics, etiology of nephrotic syndrome and related treatments, surgical procedures and anesthetic techniques, and pre-and postoperative treatments. Adverse events occurring during the intraoperative period and up to the fifth postoperative day were recorded. Results: Data on eight patients who underwent 24 surgical or interventional procedures under general anesthesia over the study period were reviewed. Three patients had steroid-resistant nephrotic syndrome and five patients had congenital or infantile nephrotic syndrome. Five patients had progressed to end-stage renal failure requiring dialysis. General anesthesia was performed for: nephrectomy (n = 9), central venous catheter insertion (n = 8), peritoneal dialysis catheter insertion (n = 5), and emergency surgery in two cases (acute intestinal intussusception and hemodialysis catheter insertion). Three patients were receiving aspirin and one anticoagulant therapy. No postoperative thrombosis or infections, bleeding, peripheral edema or ascites, and increase in kalemia were noted. There was no significant postoperative increase in median serum creatinine level. Conclusions: Surgical procedures were seldom associated with the occurrence of perioperative adverse events. However, larger studies are needed to confirm these results.