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Transplant anesthesia

James W Behan, Adam Sutton, Ashley Wysong
Skin cancer is the most common of human cancers and outnumbers all other types of cancer combined in the USA by over threefold. The majority of non-melanoma skin cancers are easily treated with surgery or locally destructive techniques performed under local anesthesia in the cost-effective outpatient setting. However, there is a subset of "high-risk" cases that prove challenging in terms of morbidity, mortality, adjuvant treatment required, as well as overall cost to the health care system. In our opinion, the term "high risk" when applied to skin cancer can mean one of three things: a high-risk tumor with aggressive histologic and/or clinical features with an elevated risk for local recurrence or regional/distant metastasis, a high-risk patient with the ongoing development of multiple skin cancers, and a high-risk patient based on immunosuppression...
December 2016: Current Treatment Options in Oncology
Terry C Lairmore
BACKGROUND: The last 200 years have seen remarkable achievements in the art and clinical practice of surgery. These advances include the introduction of antisepsis, anesthesia, vascular anastomosis, antimicrobials, organ transplantation, and the widespread application of minimally invasive operative procedures. Very recently, a surgical procedure has been shown to cure diabetes, representing the most effective treatment of a metabolic disorder by surgeons. METHODS: The author reviewed the major surgical milestones in the modern surgical era and prepared this monograph for presentation as the Claude H...
September 30, 2016: American Journal of Surgery
Nikhil Kumar, Christopher A Troianos, Joshua S Baisden
In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation...
October 5, 2016: A & A Case Reports
S Sachin, M C Rajesh, E K Ramdas
Surgical removal of the kidney tumor outside the body, (ex vivo renal bench surgery) followed by auto transplantation is an emerging and often done procedure to reconstruct the urinary tract. It possesses immense challenges to both the anesthesiologists and the surgeons. The risks are multiplied if you are performing the surgery on a solitary functioning kidney. Here, we are describing the anesthetic management of 70-year-old male post nephrectomy patient undergoing renal auto transplantation by bench surgery...
September 2016: Anesthesia, Essays and Researches
S H Lauz Medeiros, A de Oliveira Menezes, L Zogbi, E Frasson de Souza Montero
BACKGROUND: The ischemia/reperfusion (I/R) phenomenon can cause the dysfunction of some transplanted organs and other distant organs. Liver surgery success, including transplantations, may depend on the adverse effects of intestinal mucosa injury arising from temporary porta triad occlusion. The study objective was to examine I/R liver effects on the small intestine in rats after N-acetylcysteine (NAC) treatment. METHODS: Twenty-four male Wistar rats were randomly divided into 2 groups...
September 2016: Transplantation Proceedings
M Clerc, J Prothet, T Rimmelé
Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis...
June 2016: Hand Surgery and Rehabilitation
Mohamed Ghalayini, Pierre-Yves Brun, Pascal Augustin, Elise Guivarch, Marie Pierre Dilly, Sophie Provenchere, Pierre Mordant, Yves Castier, Philippe Montravers, Dan Longrois
Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-blocker (esmolol). Our purpose was to retrospectively review the efficacy of esmolol in this situation and hypothesize on the potential mechanisms of action and the associated risks...
September 2016: Journal of Extra-corporeal Technology
Christina Hafner, Jing Wu, Akos Tiboldi, Moritz Hess, Goran Mitulovic, Christoph Kaun, Konstantin Alexander Krychtiuk, Johann Wojta, Roman Ullrich, Eva Verena Tretter, Klaus Markstaller, Klaus Ulrich Klein
Supplemental oxygen (O2) is used as adjunct therapy in anesthesia, emergency and intensive care medicine. We hypothesized that excessive O2 levels (hyperoxia) can directly injure human adult cardiac myocytes (HACMs). HACMs obtained from the explanted hearts of transplantation patients were exposed to constant hyperoxia (95% O2), intermittent hyperoxia (alternating 10 min exposures to 5% and 95% O2), constant normoxia (21% O2), or constant mild hypoxia (5% O2) using a bioreactor. Changes in cell morphology, viability as assessed by lactate dehydrogenase (LDH) release and trypan blue (TB) staining, and secretion of vascular endothelial growth factor (VEGF), macrophage migration inhibitory factor (MIF), and various pro-inflammatory cytokines (interleukin, IL; chemokine C-X-C motif ligand, CXC; granulocyte-colony stimulating factor, G-CSF; intercellular adhesion molecule, ICAM; chemokine C-C motif ligand, CCL) were compared among treatment groups at baseline (0 h) and after 8 h, 24 h, and 72 h of treatment...
September 19, 2016: Shock
Brittney Williams, John McNeil, Andrew Crabbe, Kenichi A Tanaka
Achieving hemostasis after complex cardiovascular and transplant surgical procedures is one of the greatest challenges anesthesiologists face. Preoperative coagulation disturbances due to underlying disease or antithrombotic therapy are common, and they are worsened by intraoperative blood loss and fluid replacement. The coagulation reactions in vivo are incredibly complex interactions among blood cells, proteins, and vasculature, standing in sharp contrast to rather simple treatment options including transfusion of platelets, plasma, and cryoprecipitate...
August 27, 2016: Transfusion Medicine Reviews
Helge Eilers
No abstract text is available yet for this article.
September 6, 2016: Liver Transplantation
Vesa Anttila, Henri Haapanen, Fredrik Yannopoulos, Johanna Herajärvi, Tuomas Anttila, Tatu Juvonen
In remote ischemic preconditioning (RIPC) short periods of non-lethal ischemia followed by reperfusion of tissue or organ prepare remote tissue or organ to resist a subsequent more severe ischemia-reperfusion injury. The signaling mechanism of RIPC can be humoral communication, neuronal stimulation, systemic modification of circulating immune cells, and activation of hypoxia inducible genes. Despite promising evidence from experimental studies, the clinical effects of RIPC have been controversial. Heterogeneity of inclusion and exclusion criteria and confounding factors such as comedication, anesthesia, comorbidities, and other risk factors may have influenced the efficacy of RIPC...
September 5, 2016: Scandinavian Cardiovascular Journal: SCJ
Che-Hao Hsu, Yung-Chi Hsu, Go-Shine Huang, Chih-Cherng Lu, Shung-Tai Ho, Wen-Jinn Liaw, Yi-Ting Tsai, Chih-Yuan Lin, Chien-Sung Tsai, Tso-Chou Lin
Inhalation anesthetics provide myocardial protection for cardiac surgery. This study was undertaken to compare the perioperative effects between isoflurane and fentanyl-midazolam-based anesthesia for heart transplantation. A retrospective cohort study was conducted by reviewing the medical records of heart transplantation in a single medical center from 1990 to 2013. Patients receiving isoflurane or fentanyl-midazolam-based anesthesia were included. Those with preoperative severe pulmonary, hepatic, or renal comorbidities were excluded...
August 2016: Medicine (Baltimore)
Claudia Claroni, Giulia Torregiani, Marco Covotta, Maria Sofra, Alessandra Scotto Di Uccio, Maria E Marcelli, Alessia Naccarato, Ester Forastiere
BACKGROUND: In many clinical conditions that involve free flaps and tissue transplantations the possibility of minimizing ischemia-reperfusion injury can be a determinant factor for the success of the surgery itself. We hypothesize that preconditioning with sevoflurane is a protective factor against ischemia-reperfusion injury. METHODS: In this randomized controlled trial, patients ASA I-II undergoing breast reconstruction with deep inferior epigastric perforator flaps were allocated into two groups and analyzed: group BAL included patients who received balanced anesthesia with sevoflurane for 30 min before removal of the flap and throughout the surgery...
2016: BMC Anesthesiology
Sophie Heinke, Barbara Ludwig, Undine Schubert, Janine Schmid, Thomas Kiss, Anja Steffen, Stefan Bornstein, Stefan Ludwig
BACKGROUND: Safe and reliable diabetes models are a key prerequisite for advanced preclinical studies on diabetes. Chemical induction is the standard model of diabetes in rodents and also widely used in large animal models of non-human primates and minipigs. However, uncertain efficacy, the potential of beta-cell regeneration, and relevant side effects are debatable aspects particularly in large animals. Therefore, we aimed to evaluate a surgical approach of total pancreatectomy combined with splenectomy for diabetes induction in an exploratory study in Goettingen minipigs...
September 2016: Xenotransplantation
B Błaszczyk, B Wrońska, M Klukowski, E Flakiewicz, M Kołacz, L Jureczko, M Pacholczyk, A Chmura, J Trzebicki
BACKGROUND: Early extubation is a standard procedure after liver transplantation (LT). METHODS: The preoperative and perioperative data of 506 adult patients undergoing LT from July 2000 to March 2015 were analyzed. The goal of this study was to determine preoperative and perioperative independent predictors of early tracheal extubation. RESULTS: Of the 506 study patients, 73.7% were extubated early after LT. Patients in this group exhibited better preoperative and perioperative outcomes...
June 2016: Transplantation Proceedings
Teiji Sawa, Mao Kinoshita, Atsushi Kainuma, Koichi Akiyama, Yoshifumi Naito, Hideya Kato, Fumimasa Amaya, Keiji Shigemi
Arterial pulse waveform analysis (APWA) with a semi-invasive cardiac output monitoring device is popular in perioperative hemodynamic and fluid management. However, in APWA, evaluation of hemodynamic data is not well discussed. In this study, we analyzed how we visually interpret hemodynamic data, including stroke volume variation (SVV) and stroke volume (SV) derived from APWA. We performed arithmetic estimation of the SVV-SV relationship and applied measured values to this estimation. We then collected measured values in six anesthesia cases, including three liver transplantations and three other types of surgeries, to apply them to this SVV-SVI (stroke volume variation index) plot...
August 4, 2016: Journal of Clinical Monitoring and Computing
Jordi Monés, Marta Leiva, Teresa Peña, Gema Martínez, Marc Biarnés, Miriam Garcia, Anna Serrano, Eduardo Fernandez
PURPOSE: To establish the dose of subretinal sodium iodate (NaIO3) in order to create a toxin-induced large animal model of selective circumscribed atrophy of outer retinal layers, the retinal pigment epithelium (RPE), and photoreceptors, by spectral-domain optical coherence tomography (SD-OCT) and immunocytochemistry. METHODS: Fifteen male and female healthy Yorkshire pigs received unilateral subretinal escalating doses of NaIO3 under general anesthesia. In all the animals, volumes of 0...
August 1, 2016: Investigative Ophthalmology & Visual Science
V Perilli, P Aceto, T Sacco, C Modesti, P Ciocchetti, F Vitale, A Russo, G Fasano, A Dottorelli, L Sollazzi
Graft and patients survival are the main goal of anesthesiological management in patients undergoing liver transplantation (LT). Even if anesthesiological practice sustained major developments over time, some evidence-based intraoperative strategies have not yet been widely applied. The aim of this review was to summarize intraoperative anesthesiological strategies which could have the potential to improve LT graft and/or recipient survival. Monitoring must be as accurate as possible in order to manage intraoperative hemodynamic changes...
July 2016: European Review for Medical and Pharmacological Sciences
Xiaofei Qi, Xiaolei Wang, Xiaolei Huang, Chenhong Wang, Yin Gu, Yuantao Li
INTRODUCTION: Pregnancy after organ transplantation is becoming increasingly common. However, reports of the anesthesia for such patients are rare. Heart transplant recipients are always accompanied with pathophysiological changes and present anesthesiologists with challenge. CASE DESCRIPTION: We reported a case of anesthesia management of gravida undergoing cesarean section 10 years after cardiac transplantation. We used two points spinal and epidural anesthesia, combined with phenylephrine throughout the surgery...
2016: SpringerPlus
Zurab Kakabadze, Nickolas Kipshidze, Konstantine Mardaleishvili, Gocha Chutkerashvili, Irakli Chelishvili, Albrecht Harders, George Loladze, Gocha Shatirishvili, Nodar Kipshidze, David Chakhunashvili, Konstantine Chutkerashvili
Introduction. A total of 18 patients, with complete motor deficits and paraplegia caused by thoracic and lumbar spine trauma without muscle atrophy or psychiatric problems, were included into this study. Materials and Methods. The bone marrow was aspirated from the anterior iliac crest under local anesthesia and the mononuclear fraction was isolated by density gradient method. At least 750 million mononuclear-enriched cells, suspended in 2 mL of saline, were infused intrathecally. Results and Discussion. The study reports demonstrated improvement of motor and sensory functions of various degrees observed in 9 of the 18 (50%) cases after bone marrow stem cell transplantation...
2016: Stem Cells International
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