Systems Review 3: Pediatrics, Geriatrics, Transplants Flashcards
Vital signs for neonate
RR=40, HR=140, B/P=65/40
Vital signs for 12 month old
RR=30, HR=120, B/P=95/60
Vital signs for 3 year old
RR=25, HR=100, B/P=100/70
Vital signs for 12 year old
RR=20, HR=80, B/P=110/60
What are basic physiological changes that occur in elderly?
Basal organ function unchanged
Decreased functional reserve
Decreased ability to compensate
Hearing loss
Decrease in cardiac output after age 30
Appears to decrease approximately 1 % per year after age 30.
Heart rate decreased due to relative “beta-blockade”
What happens to BMR in elderly?
Decreases 1% per year after age 30
O2 consumption up 200-400%, and hypothermia can prolong anesthesia
How fast do each of the following organs have to be transplanted from time of harvest?
Heart and lungs?
Liver?
Pancreas?
Kidneys?
Transplant times vary due to cold ischemia time (CIT) and proximity of transplant center to hospital, ublood type, medical urgency, wait time, donor size and tissue typing.
Heart and lungs - 4-6 hours (Status 1A, 1B and status 2/Lung Allocation Score)
Liver - 8-10 hours (a status system and MELD/PELD score)
Pancreas - 15 hours
Kidneys - 24-36 hours
What is the pathophysiology of Acute Liver Failure?
Similar to septic shock including decreased SVR, encephelopathy and cerebral edema can occur, compromised immune system and increase in ICP
What is the pathophysiology of ESLD?
Can be acute or chronic, portal hypertension occurs that can lead to esophogeal and adominal varices.
Increased sphlanchnic hydrostatic pressure and hypoproteinemia leads to the formation of ascites.
Porto-pulmonary hypertension (PoPH)
Occurs in around 4–6% of ESLD patients
Pulmonary vascular resistance is increased and pulmonary artery pressure (PAP) is high
Severe PoPH, particularly with right ventricular pressure overload, carries a poor prognosis
Hepatopulmonary Syndrome (HPS)
As high as 20%
Disordered pulmonary capillary vasodilation and ventilation–perfusion mismatch
Hypoxia, and also exhibit orthodeoxia
May relieve itself over time is transplant is successful, however, it is an additional risk factor for post-transplant mortality
Common preoperative tests for Liver Transplants
Echocardiography
Cardiopulmonary Exercise Testing
Coronary Angiography
Evaluation of the Pulmonary Circulation
Intraoperative considerations for liver transplants
Used balanced anesthesia, and avoid volatile agents
uCVP, PA cath, A-line usually after induction
Blood products available and large bore IV access
What is the reperfusion effect?
In the neohepatic phase, there is a lot of hemodynamic instability. After the release of the portal vein and IVC clamp release of potasium and hydrogen ions and cold blood, microthrombi are released that can lead to hypotension, arrythmias and even cardiac arrest
Post reperfusion syndrome - prolonged hypotension and hyperkalemia that requires inotropes and pressors to maintain perfusion, may development significant fibrinolysis requiring treatment.
