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anesthetic management for organ procurement

Aparna Dalal
Face transplantation is a complex vascular composite allotransplantation (VCA) surgery. It involves multiple types of tissue, such as bone, muscles, blood vessels, nerves to be transferred from the donor to the recipient as one unit. VCAs were added to the definition of organs covered by the Organ Procurement and Transplantation Network Final Rule and National Organ Transplant Act. Prior to harvest of the face from the donor, a tracheostomy is usually performed. The osteotomies and dissection of the midface bony skeleton may involve severe hemorrhagic blood loss often requiring transfusion of blood products...
December 24, 2016: World Journal of Transplantation
Aparna Dalal
Intestinal transplantation is a complex and challenging surgery. It is very effective for treating intestinal failure, especially for those patients who cannot tolerate parenteral nutrition nor have extensive abdominal disease. Chronic parental nutrition can induce intestinal failure associated liver disease (IFALD). According to United Network for Organ Sharing (UNOS) data, children with intestinal failure affected by liver disease secondary to parenteral nutrition have the highest mortality on a waiting list when compared with all candidates for solid organ transplantation...
April 2016: Transplantation Reviews
T Anthony Anderson, Peter Bekker, Parsia A Vagefi
PURPOSE: While a few publications specify the anesthetic implications of either brain or cardiac death, they lack detail on how to provide anesthesia during organ donation surgery. We provide a thorough description of important anesthetic considerations during organ donation surgery in patients with either brain or cardiac death. SOURCE: A thorough literature review was undertaken to locate all relevant articles that describe systemic effects of brain and cardiac death and their anesthetic implications...
May 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Sher-Lu Pai, Stephen Aniskevich, Eduardo S Rodrigues, Timothy S Shine
Orthotopic liver transplantation (OLT) recipients have been reported to have decreased perioperative opioid and intraoperative inhalational anesthetic requirements when compared to patients without liver disease undergoing other types of major abdominal surgeries. The severity of the liver disease and the process of the transplantation itself may alter the pharmacokinetic and pharmacodynamic effects of different pain medications. Chemical injury of the liver and the high degree of surgical stress may also increase the levels of neuropeptides involved in pain modulation...
2015: Current Clinical Pharmacology
G Martucci, G Burgio, M Spada, A F Arcadipane
Living donor transplantation is an accepted clinical practice in select transplant centers in Western countries to increase the availability of organs, while is standard practice in East Asian transplant programs. Living-donor right hepatic lobe resection is a particularly risky operation, with two mandatory outcomes: no serious complications for the donor, and an optimal graft-recipient body weight ratio. The use of robotic surgery has increased worldwide thanks to its minimally invasive approach, and is now becoming suitable for living donor procurement...
July 2013: European Review for Medical and Pharmacological Sciences
Miyuki Tanabe, Shigekazu Sugino, Ryo Miyashita, Tomohiko Kimijima, Eichi Narimatsu, Michiaki Yamakage
A 60-year-old woman declared brain dead was scheduled for organ donation. We continuously measured total hemoglobin values (SpHb) using a Radical-7 monitor (Masimo Co, Irvine, CA, USA) to maintain the functions of organs and oxygen delivery. At the start of surgery, the SpHb value was 9.3 g x dl(-1). Packed red blood cells were transfused immediately No anesthetics or opioids were used during the operation. Blood pressure suddenly decreased to below 80 mmHg because of bleeding, manipulation of organs, and/or compression of the vena cava...
June 2013: Masui. the Japanese Journal of Anesthesiology
Sofia Fischer, Kathryn E Glas
Perioperative anesthetic management for cardiac transplantation is reviewed. Recent developments in adult cardiac transplantation are noted. This review includes demographics and historical results, recipient and donor selection and evaluation, mechanical circulatory support and heart transplantation techniques, and patient management immediately postimplantation.
June 2013: Anesthesiology Clinics
Vito Fanelli, Luciana Mascia
PURPOSE OF REVIEW: One of the newest strategies to enlarge the pool of organ donors is to consider the category of donors after cardiac death rather than only after brain death. Prompt and accurate identification of potential donors and appropriate care is necessary to optimize the management of nonheartbeating donors. RECENT FINDINGS: Organ procurement derived from donors after cardiac death is becoming a part of the policy of major transplantation hospitals, forcing them to consider the practical interventions and ethical implications regarding this practice...
June 2010: Current Opinion in Anaesthesiology
Murray Blackstock, Dermot W McKeown, David C Ray
BACKGROUND.: The continuing shortfall of organs for transplantation has increased the use of donation after cardiac death (DCD). We hypothesized that some patients who undergo tracheal intubation in the emergency department (ED) and who are assessed for, but not admitted to, critical care might have potential for controlled DCD. METHODS.: We identified all patients who underwent tracheal intubation in the ED between 2004 and 2008 and studied their records to identify those not admitted to an intensive care unit...
May 15, 2010: Transplantation
Ann Walia, Roman Schumann
PURPOSE OF REVIEW: Over the last 40 years, liver transplantation developed from a compassionate attempt to save the lives of patients with end stage liver disease into a sophisticated therapy, for which 1-year survival rates now approach 90%. To understand the evolution of anesthetic perioperative care, its origin needs to be considered. The implications of this evolution on patient outcomes are important and have not been comprehensively reviewed. This article attempts to fill this gap...
June 2008: Current Opinion in Organ Transplantation
Gregory I Snell, Donald S Esmore, Glen P Westall, Silvana Marasco, Tom Kotsimbos, David V Pilcher, Paul Myles, Anne Griffiths, Bronwyn J Levvey, Trevor J Williams
There has been considerable evolution in the pre-, peri- and postoperative management of patients with severe lung disease undergoing LTx. Compared with where we started at the Alfred Hospital in 1990, in 2008 we now recognize that the majority of donor lungs that are offered for LTx (including DCD lungs) are useable, patients with a wide range of ages and disease processes are suitable to be considered for LTx and modern surgical, anesthetic and ICU management should result in a 90% one-year survival rate...
2007: Clinical Transplants
L Gajate Martín, E Elías Martín, A Martínez Pérez, C Carrasco Seral, F Alvarez Utrera, A Pablo de Pajares, J Pinto Corraliza, A Honrubia Checa, E Vicente de López, Y Quijano-Collazo, R Bárcena Marugan
Intestinal transplantation is becoming more firmly established as a treatment for intestinal failure in patients whose home parenteral nutrition regimens have caused serious side effects. Outcomes have improved spectacularly over recent years thanks to the refinement of surgical techniques and the introduction of new immunosuppressants, and also to greater experience in anesthetic and postoperative management of intestinal transplant patients. The main causes of high morbidity and mortality continue to be sepsis and acute rejection of the graft...
November 2004: Revista Española de Anestesiología y Reanimación
Richard J Hendrickson, Frederick M Karrer, Michael E Wachs, Kellee Slater, Thomas E Bak, Igal Kam
PURPOSE OF REVIEW: Pediatric liver transplantation is a challenging and exciting field for all healthcare providers involved with children who have end-stage liver disease. Graft and patient survival continue to improve due to improvements in medical, surgical, and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. This review will describe recent advances in pediatric liver transplantation. RECENT FINDINGS: Although pediatric cases only represent approximately 10% of the total patients on the waiting list, the number of deaths on the waiting list increased from 196 to 1753 between 1988 and 1999...
June 2004: Current Opinion in Pediatrics
D Santerre, R H Chen, A Kadner, D Lee-Parritz, D H Adams
A detailed anaesthetic technique for baboons (Papio anubis) undergoing heterotopic abdominal cardiac xenotransplantation is described. Twenty-two baboons served as transplant recipients. Donors were either crossbred farm pigs (Sus scrofa) (n = 4) or transgenic pigs (Sus scroefa) (n = 18) expressing human complement regulatory proteins on the endothelium. Intra-operative management was complicated by the physiological consequences of infrarenal. abdominal aortic cross-clamping, in addition to the immunological sequelae related to cross-species transplantation...
May 2001: Veterinary Research Communications
L Sheets
Liver transplantation celebrated its twenty-fifth anniversary in 1988. However, only in the last decade has it been accepted as a viable treatment alternative for patients with end-stage liver disease. There currently are over 70 centers in the United States with liver transplant programs. Over 1500 transplants were performed in 1988, and there were 644 people awaiting suitable liver donors, with an average of 150 to 200 patients added to the list each month. This growth has resulted from many factors, including improved operative techniques and anesthetic management, immunosuppressive therapies, and improvements in donor recovery, which has served to increase the acceptable organs available for transplantation...
December 1989: Nursing Clinics of North America
J D Perkins, G A Fromme, B J Narr, P A Southorn, C L Marsh, S R Munn, D E Engen, S Sterioff
Better perioperative and operative management techniques have contributed to an improvement in the success rate of pancreas transplantation. Because of a shortage of donor organs, the criteria for acceptability of the allograft have been liberalized, and the development of techniques such as combined liver and pancreas procurement has increased allograft availability. Major advances have been made in organ preservation. Currently, pancreas allografts can routinely be stored for 18 to 24 hours. The technique of pancreaticoduodenal transplantation with a duodenocystostomy for the exocrine drainage is widely used...
April 1990: Mayo Clinic Proceedings
I F González-Cancel, C Mahecha
Heart transplantation has become a widely and frequently used therapeutic approach for end stage cardiac disease. However, there is no absolute agreement concerning certain aspects related to the clinical and anesthetic management of the donor and the recipient. The most common indications for heart transplantation are the dilated cardiomyopathy of idiopathic origin and the ischemic cardiomyopathy. There are several contraindications for transplantation. Once a patient is initially accepted as a possible candidate for transplantation, it is important to rule out the presence of fixed pulmonary vascular hypertension, since its presence has been associated with dismal results...
September 1991: Boletín de la Asociación Médica de Puerto Rico
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