Liver Transplant

Question 1

how would you evaluate this patient’s cardiac status

Answer 1

h and p
any episodes of chest pain, SOB, light headedness
baseline exercise tolerance
PE: CHF signs such as JVD, pedal edema, pulmonary edema

look at EKG and Echo

Question 2

MAC values with patients and cirrhosis

Answer 2

may need higher bc often 2/2 chronic alcohol use

Question 3

what are the factors associated with liver disease that lead to the accumulation of ascites

Answer 3

hypoalbuminemia, portal hypertension, and water retention 2/2 ADH

Question 4

severe pHTN >__mmhg is contraindication to liver transplant

Answer 4

50

Question 5

potential complications of V-V bypass

Answer 5

arm edema, air embolism, vascular injury

Question 6

anesthetic management for traditional technique

Answer 6

V-V bypass
volume load patient with target CVP 10-20 and administer vasopressor boluses prior to clamping of the vessels

Question 7

surgeon is about to reperfuse what will happen physiologically?

what would you do to prepare?

Answer 7

pts blood through new liver so many metabolic product into the main circulation

lead to decrease in cardiac contractility, CO, SVR and rise in pulmonary vascular resistance and serum hydrogen and potassium ion concentrations

Plan: keep pts intravascular volume optimized, check ABG and H/H to correct acid base and electrolyte disorder Q30 minutes, and transfuse as needed
have pressor, calcium, insulin, sodium bicarb

Question 8

what is reperfusion syndrome

Answer 8

hemodynamic instability of unknown mechanism during first 5 minutes of reperfusion associated with hyperkalemia and hemodynamic fluctuations like hypotension, bradycardia, elevated PAP and SVT

Question 9

pt bleeding and transfusing products what do you want to be careful with when transfusing lots of fluid

Answer 9

watch CVP closely since high CVP may lead to congestion of the new liver and trigger further bleeding and/or graft dysfunction