Organ Donation & Transplant - Quiz 2 Flashcards
What is the Max Cold Ischemic Time for Heart & Lungs?
4 - 6 hrs.
What is the Max Cold Ischemic Time for Livers?
12 - 24 hrs.
What is the Max Cold Ischemic Time for Kidneys?
72 hrs
How is Death defined?
Irreversible cessation of circulatory, respiratory, or all functions of entire brain
The Organ Donor designation on a driver’s license is ______ and ______ require family persmission
The Organ Donor designation on a driver’s license is LEGALLY BINDING and DOES NOT require family persmission
What are the criteria for diagnosing Brain Death?
Loss of Cerebral Fxn
Loss of Brainstem Fx
Supporting Documentation (EEG, CBF)
What are common physiological changes after Brain Death?
Hypotension
Arterial Hypoxemia
Hypothermia
Arrhythmias
When is anesthesia needed for Organ Procurement?
Anesthesia is absolutely required for Donation after Brain Death (DBD), but NOT for Donation after Cardiac Death (DCD)
When is anesthesia no longer needed for organ recovery?
After clamping of Proximal Aorta, unless lungs are gonna be harvested and needs Hyperventilation & Extubation
What inidicates adequate perfusion to maintain Viable Organs?
SBP > 100
CVP: 8 - 12
O2 Sat > 96%
Urine Output > 100cc/hr
Organ Donors should have no past medical history of what?
HTN
DM
Cancer
Kidney Disease
Heart Disease
Which muscle relaxants are frequently used for Organ Recovery?
Pancuronium & Vecuronium
What has improved the success of organ transplants?
Cyclosporine
Azathioprine
OKT3
Steroids
Donor:Recipient Typing
What are the Major indications for Kidney Transplant?
DM
HTN-induced Nephropathy
Glomerulonephritis
Polycystic Kidney Disease
What is included in the Pre-Op eval for Kidney Transplants?
Cardiac Risks
Volume Status
Hgb: 8 or above
Fix Lytes
Gastroparesis & Aspiration Risks
What is a critical pre-op evaluation for patients w/ DM1 undergoing Kidney Transplant?
Airway Evaluation & PFTs
They are stiff and have limited CROM
Why should N2O be avoided for Kidney Transplants?
Expands bowel and gets in the way
Avoid _______ drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised
Avoid ALPHA ADRNERGIC drugs because transplanted kidney is senstive to sympathomimetics and blood flow to the organ can be compromised
Which NMB should be used for Kidney Transplants?
Succinylcholine if K+ is Normal
otherwise, Cisatacurium or Mivacurium
What can be given as a prophylaxis for diabetic gastroparesis regarding Kidney Transplants?
Sodium Citrate
Citric Acid
Reglan
H2 Blockers 6-12 hrs before induction
When should Diuretics be given to maintain Renal Perfusion & Enhance Urine Production?
Before unclamping vascular supply to Transplanted Kidney
How should Hypotension be managed during Reperfusion of the Kidney Graft?
Crystalloid
Colloid
Low-Dose Dopamine
What should be given for HYPERtension during Emergence for Kidney Transplant surrgery?
Short-Acting Anti-Hypertensives
&
AVOID Long-Acting B-Blockers to prevent K+ Increase
How do patients w/ Chronic Liver Dysfunction present regarding CV?
Hyperdynamic Circulation
Low PVR
Increased Cardiac Index
What is a major pre-op eval for Liver Transplant?
Cardiac Function & Ischemic Potential
What happens during the Pre-Anhepatic Phase?
Lysis of Adhesion
Liver Mobilization
Hepatic Artery, CBD, Supra & Infra Vena Cava, Portal Vein Dissection
Possible Shunting Procedure to redirect Venous flow into Venous Circ.
What are the anesthetic considerations for the Pre-Anhepatic Phase?
Hemorrhage & CV Instability
Coagulopathy
Impaired Venous Return from IVC Clamping
HYPOcalcemia
HYPERkalemia
Metabolic Acidosis
What happens in the Anhepatic Phase?
- Clamping of Hepatic Blood Flow
- Bicaval Clamp – ↓Preload, Profound Hypotension & Tachycardia
- Piggyback Clamp – IVC Side-clamp – preserves some caval flow & preload
- Venovenous Bypass – rarely used
- Remove Liver including Vena Cava
- New Liver Implant & Flush w/ Fluid or Colloid
What are the anesthetic considerations during the Anhepatic Phase?
Hemorrhage
Coagulopathy
HYPOthermia
↓Renal Function
Inotrope & Pressor Support
Citrate Intoxication
HYPOcalcemia
What happens during the Neohepatic Phase?
Reperfusion - Unclamping of Portal Vein, Hepatic Artery, & Vena Cava
Hypodynamic Instability
What are the anesthetic considerations for the Neohepatic Phase?
Correct Lytes
Keep K+ < 4.5
Epi & Levo Support
AVOID Fluid bolus before Unclamping
Reperfusion Syndrome
What is Reperfusion Syndrome?
↓CO, HR, & BP
Brady-Arrythmias
Rapid K+ Increase
Severe Coagulopathy
HYPOthermia
What are some early signs of a functioning Liver Graft?
Intra-Op Bile Production
Intra-Op Negative Base Excess Correction
Improved Coagulation
What Post-Op complication from Liver Transplant may require Re-transplantation?
Thrombosis of Hepatic Artery & Portain Vein
What is Eisenmenger’s Syndrome?
Extremely High PAP causing oxygen-poor blood to flow from right to left ventricle
What is important aspect of a Post-Heart Transplant regarding catecholamines?
Denervation leading to no sensory, sympathetic, and parasympathetic innervations
