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7835 Exam IV > Mod13: Anesthesia for Organ Procurement > Flashcards

Mod13: Anesthesia for Organ Procurement Flashcards

1
Q

Anesthesia for Organ Procurement

When a hospital identify a potential donor, which organization is notified?

A

The local organ procurement organization (OPO)

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2
Q

Organ Procurement

Once notified, which next steps are undertaken by the OPO?

A

Donor evaluation

Brain Death diagnosis confirmed or testing in progress

Consent once Brain Death diagnosis confirmed

Testing and Allocation of organs

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3
Q

Organ Procurement

The local agency that coordinate activities with the recovery of organs is known as:

A

OPO

Organ Procurement Organization

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4
Q

Organ Procurement - OPO

Why do OPO works within Federally designed service area?

A

To ensure no competition for organs

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5
Q

Organ Procurement - OPO

Which agency certifies OPOs?

A

CMS

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6
Q

Organ Procurement - OPO

Which agency/legislation regulates OPOs?

A

Medicare/Medicaid Act

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7
Q

Organ Procurement - OPO

True or False: Working Relationships exist betwen hospitals and the OPO in the OPO service area

A

True

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8
Q

Organ Procurement - OPO

Approximately how many OPO’s in the U.S.?

A

62

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9
Q

Organ Procurement - CMS Regulations

Based on on CMS Regulations, which other entities must Hospitals sign an agreement with regarding organ procurement?

A

Organ Procurement Organization (OPO’s)

Tissue Bank

Eye Bank

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10
Q

Organ Procurement - CMS Regulations

Hospitals must notify the OPO about what?

A

Every death and every imminent death (brain death) that occurs in the hospital

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11
Q

Organ Procurement - CMS Regulations

Hospital must work in conjunction with the OPO to assure that the family of every potential donor is offered what?

A

The option of donation, if they are good candidate

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12
Q

Organ Procurement - CMS Regulations

Any individual who initiates discussion or provides information about donation or requests donation must be:

A

an OPO Representative or have been

Trained by the OPO

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13
Q

Organ Procurement - CMS Regulations

Any individual who initiates discussion or provides information about donation or requests donation must be an OPO representative or have been trained by the OPO

Penalties for failure to comply include:

A

Lose JCAHO accreditation

Lose Medicare/Medicaid Funding

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14
Q

Organ Donation - Background Information

True or False: Organ Transplantation may be the only treatment for some chronic diseases & disorders

A

True

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15
Q

Organ Donation - Background Information

Number of Americans awaiting transplantation (Waiting Lists):

A

Currently over 115,000

Someone added every 10 minutes

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16
Q

Organ Donation - Background Information

Of those currently awaiting transplants, how many are Georgians*?

A

10,500

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17
Q

Organ Donation - Background Information

How many people die each day awaiting transplants?

A

20

Source: United Network for Organ Sharing Data

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18
Q

Organs and Tissues that Can be Donated

ORGANS that Can be Donated include:

A

Heart - Lung - Liver - Kidney - Pancreas

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19
Q

Organs and Tissues that Can be Donated

TISSUE that Can be Donated include:

A

Heart Valve - Bone - Skin - Cornea - Intestine

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20
Q

Definition of Brain Death

What’s the Anatomical Definition of Brain Death?

A

Destruction of all neural tissue above the 1st vertebrae

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21
Q

Understanding Brain Death

In essence, what is Brain Death?

A

Loss of brain stem function

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22
Q

Understanding Brain Death

Absence of which brain stem reflexes constitute clinical diagnosis of Brain Death?

A

Pupillary light reflex

Corneal reflexes

Oculocephalic reflex

Oculovestibular reflex

Apnea test

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23
Q

Understanding Brain Death

How can the Oculocephalic reflex be tested?

A

Doll’s head maneuver

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24
Q

Understanding Brain Death

How can the Apnea test be performed?

A

Normothermic patient failling to initiate a breath when arterial CO2 is > 60

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25
Q

Potential Donors

Potential donors are patients who have sustained head injury and/or brain insult from which causes?

A

ICH 2° HTN, Aneurysm

GSW to head

Blunt trauma to head

Brain tumor

Extensive chart review follows to make sure a potential donor is indeed a good candidate

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26
Q

Donor Management

What is responsible for hemodynamic instability that usually follows Brain death?

A

Wide swings in hormone levels

Systemic inflammation

Oxidant stress

All negatively impact organ function

27
Q

Donor Management

What cause the systemic vasoconstriction (especially in the coronary circulation) usually seen after Breath Death? How can this be managed?

A

Increased levels of Epinephrine and Norepinephrine in the body

Can be managed with Verapamil to prevent ischemic changes in the heart

28
Q

Donor Management-Hemodynamics

What’s the fluid management goal in a transplant donor?

A

Keep pt euvolemic (critically important)

CVP between 6-12 mm Hg

29
Q

Donor Management-Hemodynamics

Why should you keep Na <155 mmol/L and prevent hypernatremia?

A

Hypernatremia is associated with many systemic issues

30
Q

Organ Procurement - Donor Surgery

These are busy cases for anesthesia. What would you being doing and what are your overall goals?

A

Drawing and treating labs

Ensuring donor stays stable while organs are being harvested

31
Q

Organ Procurement - Donor Surgery

What will you eed for Surgery?

A

Drugs - Electrocardiograph

Arterial pressure catheter (for lab draws)

CVP catheter - Urinary catheter

Ventilator - Fluid warmers - HME - NGT

Tracheal suction catheters - Infusion Pumps

Heparinized blood sampling syringes (ABG draws)

32
Q

Organ Procurement - Donor Surgery

Which drugs will you need for Surgery?

A

NMBs - Mannitol - Lasix - Dopamine - Heparin

Epinephrine - Bicarb - Lidocaine - Verapamil

33
Q

Operative Management

Prior to surgery, where is donor assessment performed?

A

in the ICU, just as with any other case

34
Q

Operative Management

What should you check in the donor’s chart?

A

Brain Death pronouncement

Noting date and time of death

Look for signature of physician

Consent for donation

Should be signed by donor’s next of kin

35
Q

Operative Management

What should you carefully assess in the donor’s clinical presentation?

A

What support they are already on

How stable they are

Because of all the changes to happen intraop, preparation must be based on based on current/recent presentation

36
Q

Operative Management

True or False: Donor’s operative management will continue as it has been preoperatively, making necessary adjustments in treatment to maintain BP.

A

True

37
Q

Operative Management

Vent settings should be set to match ICU settings. When will you Not keep them at 100% FiO2?

A

If you are having the lungs transplanted

Keep < 60% in this case

If you are Not having the lungs transplanted

Keep at 100%

38
Q

Operative Management

What could happen if FiO2 is > 60% and you are having the lungs transplanted?

A

Pulmonary Oxygen toxicity

39
Q

Operative Management

Why should you keep PEEP as low as possible, preferrably not more than 5 cmH2O?

A

Any PEEP > 5 cmH2O will increase Right atrial pressure

which will further increase Hepatic congestion

which could make the liver unsuitable for transplant

40
Q

Operative Management

Why must Mannitol, Lasix and Heparin be ready to administer

A

Administration of these is extremely time sensitive

41
Q

Operative Management

True or False: Organ donors require anesthesia for hypnosis

A

False

Organ donors do not require anesthetics for hypnosis

But active reflexes often necessitate neuromuscular blocking agents

42
Q

Operative Management

What are the benfits of volatile agents in donor’s surgery?

A

Ischemic preconditioning

Will reduce the risk of ischemic reperfusion injury that can occur when that organ is transplanted onto the recipient

43
Q

Operative Management - Spinal Movements

In what proportion of donors are spontaneous spinal movements or spinal reflexes seen?

A

1/3

44
Q

Operative Management - Spinal Movements

How do Spinal Movements manifest?

A

Spontaneous “spinal” movements of limbs

Arching of the back

45
Q

Operative Management - Spinal Movements

What are negative consequences of spinal or spontaneous movements

A

May interfere with surgery

Can cause catecholamine release and HTN

46
Q

Operative Management - Spinal Movements

How can spinal or spontaneous movements be prevented?

A

Long acting NMBAs

47
Q

Operative Management

What’s the typical incision in donor’s surgery?

A

Midline incision

48
Q

Operative Management

How does donor’s surgey typically last?

A

2-4 hours

Depends on which and how many organ(s) are recovered

49
Q

Operative Management

Why is the potential for confusion greater in donor’s surgery?

A

Lots of people in the room

Roles sometimes unknown

50
Q

Operative Management

If the heart is being recovered and a central line is in place, what will you be asked to do?

A

To withdraw the line prior to cross-clamping

Prevents central line from being trapped in that cross clamp area and potentially cause a shunt later when they excise the area, they could cut through the catheter and potentially loose blood out of that opening

51
Q

Operative Management

If the lungs are being recovered, what will you be asked to do after cross-clamping? Why?

A

To manually inflate and deflate the lungs a couple of times

This will prevent small airway closure before the lung is transported

52
Q

Operative Management

Why are bradyarrhythmias in pts with brain death unresponsive to atropine?

A

Because the brain stem is non functioning

53
Q

Operative Management

How should you treat bradyarrhythmias in brain death patients?

A

With direct-acting, beta-sympathomimetic agents

such as Isoproterenol

54
Q

Operative Management

How can you treat ventricular arrhythmias in brain death patients?

A

Lidocaine

55
Q

Operative Management

During organ procurement, how do you know which physiologic parameters to keep the donor’s in?

A

They will be very specific in what parameters they want you to keep the patient in

They will let you know what’s going on while it’s going on

They will let you know what to expect because they know No anesthesia provider is wholly comfortable with organ procurement, since we don’t do them enough

56
Q

Operative Management

What happens once the organs are taken out?

A

They will ask you to shut off your ventilator, thank you, you can shut off your monitors, and you can leave the room

And it will be weird feeling because you are used to never leaving a pt on the table.

But at this point they have taken all the organs necessary, and what’s left will start to shut down on its own, and they no longer need you in there assisting with anything else

57
Q

Facts About Transplantation

From recovery to transplantation, how long are kidneys viable?

A

24 to 36 hours

58
Q

Facts About Transplantation

From recovery to transplantation, how long is a Liver viable for?

A

6 to 8 hours

59
Q

Facts About Transplantation

From recovery to transplantation, how long is a Heart viable for?

A

4 to 5 hours

60
Q

Facts About Transplantation

From recovery to transplantation, how long is are Lungs viable for?

A

4 to 6 hours

61
Q

Facts About Transplantation

From recovery to transplantation, how long is the Pancreas viable for?

A

8 to 12 hours

62
Q

Benefits of Donation

From the donor’s family perspective, what are the benefits of donation?

A

Helps with the grieving process

Makes something positive out of a tragic situation

63
Q

Benefits of Donation

From the Recipient’s perspective, what are the benefits of donation?

A

Gift of Life

64
Q

Benefits of Donation

From the Health Care Professional’s perspective, what are the benefits of donation?

A

Makes something positive out of a tragic situation

Be it on the procurement end or the transplantation end

7835 Exam IV (21 decks)

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