Anesthesia For Abdominal Organ Transplant

Front 1

Criteria for declaration of brain death

Back 1

1. Coma
2. No spontaneous movement
3. No movement to pain
4. Lack of sedatives, hypothermia, neuromuscular blockers
5. Lack of brainstem reflexes
6. Confirmation with apnea testing

Front 2

What are the brain stem reflexes?

Back 2

1. Pupillary response to light
2. Corneal
3. Oculocephalic
4. Caloric
5. Gag, cough
6. Facial motor response

Front 3

Pathophysiologic changes associated w/ braindeath?

Back 3

1. initial hyperdynamic response w/ hypertension
2. Hypotension during anesthesia
3. Myocardial dysfunction
4. Reduced cardiac output
5. Neurogenic pulmonary edema
6. Hyperglycemia from DI
7. Coagulopathy
8. Hypernatremia, hypokalemia

Front 4

Guidelines for intraoperative management of braindeath patients?

Back 4

1. Systolic > 100, MAP > 70
2. PO2 > 100
3. UOP > 1.0 / kg
4. CVP 5-10
5. Hb > 10
6. FiO2 < 40
7. glucose less than 200

Front 5

how to manage hypotension during organ procurement?

Back 5

1. volume resuscitation w/ crystalloids / then colloids
2. May use colloids first in luing tx
3. Dopamine is the choice pressor ( but others may be used as well)

Front 6

Two most widely used solutions for organ preservation after harves? Implications?

Back 6

UW ( University of Wisconsin) has 120 mmol/L of K and HTK has 10 mmol/L of K. UW is used in livers and this increases K after reperfusion.

Front 7

Advantages to laparoscopic donor nephrectomy?

Back 7

1. safer procedure
2. more rapid convalescence
3. lower opioid consumption compared w/ open

Front 8

which kidney is preferred for donation and why?

Back 8

Either can be used but Left one is preferred due to longer vascular supply and easier surgical exposure

Front 9

Intraoperative considerations for kidney transplant?

Back 9

1. Patient is usually ASA 1 or 2
2. Good IV access needed, no need for central line
3. May want an aline
4. Have blood available
5. No nitrous because of potential sq emphesema or chance for pneumothorax
6. Have heparin ( 3000 - 5000), furosemide and mannitol ready
7. Maintain good UOP

Front 10

How much of the liver is left in a living liver donor?

Back 10

about 1/3

Front 11

How long does it take for the liver to grow back after donation to original size?

Back 11

weeks to months
Recovery of function takes longer though.

Front 12

When does the PT peak after a hepatectomy in a donor?

Back 12

PT peaks on day 2-3, and is back to normal day 5

Front 13

Is epidural anesthesia safe in liver resections?

Back 13

Yes, no complications were observed in large studies

Front 14

Anesthetic considerations for liver donation ( resection )?

Back 14

1. Good IV access ( PIV + central access)
2. OG / NG for decompression and good surgical exposure
3. A line
4. Blood available

Front 15

Prime determinant of bleeding from liver parenchyma during transection?

Back 15

Elevated CVP.
Most places will keep it below 10, low fluid administration prior to transection is necessary.