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IVA11C Transplants and Organ Harvesting
Terms in this set (16)
What is the common indication for most solid-organ transplantation, excluding lung transplants?
end-stage organ disease that is refractory to medical management and with expected life-spans < 1 year.
Which two organs are most commonly transplanted? Most frequently transplanted in the United States?
kidney and liver - accounting for more than 70% of all transplanted organs.
Kidney in US most common
Requirements needed to declare brain death.
-patient must be comatose with neither spontaneous movement nor response to painful stimuli.
-no brainstem activity confirmed by assessment of brainstem reflexes and the apnea test.
Possible causes of reversible cerebral dysfunction should also be excluded - Hypothermia, residual drug effects.
While not a specific requirement, a flat EEG is consistent with brain death.
List the six brainstem reflexes that should be absent in brain death.
Pupillary response to light
oculocephalic reflex - doll's eyes response
oculovestibular reflex - caloric response
gag and cough reflex
facial motor response.
Describe the initial and subsequent physiologic responses following brain death.
-hemodynamic instability, hormonal chaos, systemic inflammation, and oxidant stress.
-After an initial hyperdynamic response with or without tachycardia
-brain-dead patients brought to the operating room for organ recovery experience: hypotension, reduced cardiac output, myocardial dysfunction, and vasodilation (decreased SVR).
-Pituitary failure ensues leading to hypernatremia, hypokalemia, and hyperglycemia.
-Coagulopathy and hyperthermia
Anesthetic goals of organ donor management.
-Maintenance of euvolemia.
- systolic blood pressure greater than 100 mmHg
-PO2 greater than 100 g/L
-urine output greater than 100 ml/h
-hemoglobin concentration greater than 100 g/L
-CVP 5-10 mmHg
-FIO2 less than 40%
-glucose concentrations less than 200 mg/dL
-peak airway pressures less than 30 mmHg.
In what order are donor organs removed during organ recovery?
According to susceptibility to ischemia
Identify the three distinct periods that contribute to donor organ injury.
- Storage of recovered organs ex vivo during transport under hypothermic conditions from donor to patient
- implantation phase - rewarming - without reperfusion, - initial reperfusion stage with reintroduction of oxygen.
What is the only absolute contraindication to all solid organ transplantations?
What is the most common comorbidity with end-stage renal disease and cause of death in renal transplant patient?
-heart failure and cardiovascular disease
-Cardiovascular lead cause of death after renal transplantation.
What is the major intraoperative anesthetic consideration for renal transplantation?
- Maintenance of renal blood flow
- systolic pressure > 90 mmHg
-mean systemic pressure > 60 mmHg
-CVP > 10 mmHg.
List and briefly describe the three stages of liver transplantation.
- preanhepatic - dissection -phase
begins with the surgical incision and dissection and mobilization of the patient's diseased liver. During this stage the surgeons mobilize the hepatic artery, portal vein, the inferior vena cava above and below the liver, and isolate the common bile duct.
- anhepatic phase
phase begins when the blood supply to the native liver is occluded by clamping the hepatic artery and portal vein.
- reperfusion - neohepatic - phase.
Begins after reanastomoses of the major vascular structures to the donor liver and extends to the conclusion of the operation.
.What other agent may be used to treat severe acidosis during the dissection and anhepatic phases?
Trishydroxymethyl aminomethane (THAM, tromethamine) infusion
Excessive sodium bicarbonate treatment during liver transplant may lead to?
hypernatremia, hyperosmolality, and metabolic alkalosis
During dissection - preanhepatic and anhepatic phases of liver transplantation what should be anticipated?
During heart transplant, patient becomes bradycardic during rewarming phase. What do you do?
treat with pacing 90 to 100 bpm
treat with isoproterenol - inotrope
Atropine NO work
THIS SET IS OFTEN IN FOLDERS WITH...
IA02h: Respiratory Control
IA02i: Respiratory Pathophysiology
Valley Memory Master- respiratory
IA02j: Obstructive and Restrictive diseases
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