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Pulmonary hypertension: mean pulmonary artery pressure > 45 mm Hg
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- Recidivism to alcohol and drug abuse
- Extrahepatic malignancies
- Systemic sepsis
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- Pulmonary hypertension: mean pulmonary artery pressure > 35 mm Hg
- Significant cardiopulmonary disease
- Poor psychosocial support or compliance
- In the case of hepatocellular carcinoma (“Milan criteria”)
- 1 tumor > 5 cm
- >3 tumors < 3 cm
- Presence of extrahepatic tumors
- Presence of vascular invasion
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Routine setup of liver room at Columbia University Medical Center (courtesy of Dr. Tricia Brentjens)
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Induction and maintenance
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- Propofol
- Etomidate
- Midazolam (have 10 mg available)
- Fentanyl (have 3 mg available)
- Succinylcholine
- Cisatracurium (have 200 mg available)
- Isoflurane (have 2 full bottles available)
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- Epinephrine 100 mcg/mL, 10 mL
- Epinephrine 10 mcg/mL, 10 mL
- Calcium chloride 1 g in 10 mL (have 10 vials available)
- Phenylephrine 40 mcg/mL, 10 mL syringe, and 250 mL bag
- Ephedrine 5 mg/mL, 10 mL
- Atropine 100 mcg/mL, 10 mL
- Sodium bicarbonate 50 mEq (have 10 vials available)
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- Magnesium sulfate 2 g (4 mL of the 0.5 g/mL solution): Not drawn up!
- Methylprednisolone sodium 500 mg
- Mannitol 12.5 g/20 mL: Not drawn up
- Acetylcysteine: discuss with your attending physician
- Load: 150 mg/kg in 200 cc over 1 hour
- Maintenance: 50 mg/kg in 500c c D5W over 4 hours
- Then 100 mg/kg in 1 L D5W over 16 hours
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- Norepinephrine 4 mg/250 mL N saline
- Vasopressin 100 U/100 mL N saline
- Furosemide 100 mg/100 mL N saline
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- Dopamine 200 mg/250 mL premix bag
- Dobutamine 250 mg/250 mL premix bag
- Nitroglycerin 50 mg/250 mL premix bottle
- Aminocaproic acid (Amicar) ...