RT Book, Section
A1 Konia, Mojca Remskar
A1 Beebe, David S.
A1 Belani, Kumar G.
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56646241
T1 Chapter 59. Anesthesia for Kidney, Pancreas, or Other Organ Transplantation
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56646241
RD 2024/04/23
AB The  5-year  survival  of  patients  on  chronic  hemo-  or  peritoneal  dialysis  is  only  30%.  In  contrast,  the  5-year  survival  following  transplantation  for  end-stage  renal  disease  is  70%.  Therefore,  transplantation  is  considered  the  treatment  of  choice  for  patients  with  renal  failure.Living  related  kidney  transplant  is  associated  with  fewer  episodes  of  acute  and  chronic  rejection  than  cadaveric  organ  transplant.Cardiac  events  related  to  coronary  artery  disease  and  autonomic  nervous  system  dysfunction  are  the  most  common  causes  of  morbidity  and  mortality  in  the  first  year  following  kidney  or  pancreas  transplant.Significant  hypotension  upon  induction  of  general  anesthesia  is  common  in  recently  hemodialyzed  patients.  Diabetics  with  autonomic  neuropathy  are  at  increased  risk  for  severe  hypotension  and  bradycardia  during  induction  of  general  anesthesia.According  to  the  most  recent  ACC/AHA  guidelines  for  those  receiving  β-blocker  therapy,  these  drugs  should  be  continued  in  patients  preoperatively,  or  initiated  in  patients  with  a  positive  stress  test.  The  evidence  also  favors  perioperative  β-blockers  in  high-risk  patients  (more  than  3  risk  factors:  high-risk  surgery,  ischemic  heart  disease,  congestive  heart  failure,  cerebrovascular  disease,  insulin-dependent  diabetes  mellitus,  renal  failure—creatinine  >2.0  mg/dL).  Use  of  β-blockers  in  low-  and  intermediate-risk  patients  is  not  supported  by  current  available  data.Patients  with  long-standing  diabetes  often  develop  stiff  joints  due  to  glycosylation  of  the  connective  tissue  that  results  from  elevated  blood  sugars.  The  inability  to  oppose  the  palms  of  the  hands  is  1  sign  in  a  diabetic  patient  that  stiff  connective  tissue  may  be  present.  Patients  with  stiff  joints  may  be  difficult  to  intubate  and  may  require  an  awake,  fiberoptic  intubation.Adults  and  children  who  receive  hematopoietic  stem  cell  transplantation  (HSCT)  are  at  risk  for  complications,  including  respiratory  failure  or  acute  graft  versus  host  disease.  Acute  graft  versus  host  disease  is  the  most  important  complication  that  significantly  influences  clinical  outcome.  HSCT  recipients  are  at  risk  for  airway  complications  during  the  first  2  months  of  transplantation.Due  to  the  high  incidence  of  venous  thrombosis  in  patients  on  long-term  hyperalimentation,  all  patients  referred  for  intestinal  transplantation  should  undergo  preliminary  mapping  of  their  venous  access  by  Doppler  ultrasound,  and  patients  with  multiple  thrombosed  vessels  should  be  considered  for  additional  angiographic  evaluation.Small  bowel  transplantation  is  a  long  surgical  procedure  that  can  take  up  to  17  hours.  It  can  be  associated  with  large  fluid  shifts  due  to  abdominal  manipulation  and  significant  intraoperative  bleeding,  dehydration,  vascular  clamping,  long  ischemia  times,  visceral  exposure,  and  lymphatic  interruption.  Therefore,  adequate  vascular  access  is  essential.