Transplant Anesthesia

Question 1

What is max cold ischemic time for liver?

Answer 1

12-24 hours

Question 2

What is max cold ischemic time for heart and lungs?

Answer 2

4-6 hours

Question 3

What is max cold ischemic time for kidneys?

Answer 3

72 hours

Question 4

What type of donor is most common method for donation?

Answer 4

Brain death organ donors

Question 5

Which type of death is anesthesia REQUIRED for organ donation?

Answer 5

Donation after Brain Death (DBD)

Question 6

What are s/s of loss of cerebral cortical fxn?

Answer 6

1. No spontaneous movement

2. Unresponsive to external stimuli

Question 7

What are s/s of loss of brainstem fxn?

Answer 7

1. Apnea

2. Loss of cranial nerve reflexes?

Question 8

What cranial nerve reflexes are looked at specifically to dx brain death?

Answer 8

1. Papillary
2. Corneal
3. Oculocephalic
4. Oculovestibular

Question 9

What are the common physiologic derangements after brain death (4) with causes?

Answer 9

1. Hypotension (hypovolemia d/t DI or hemorrhage; neurogenic shock)
2. Arterial hypoxemia (neurogenic pulmonary edema, aspiration, pneumonia)
3. Hypothermia (hypothalamic shock)
4. Cardiac dysrhythmia (hypothermia, arterial hypoxemia, electrolyte abnormality, myocardial ischemia)

Question 10

What percent of donors are living; age requirements; Limitations

Answer 10

1. 44%
2. 18-60 years
3. NO HX of: HTN, DM, CA, heart disease, kidney disease

Question 11

When is anesthesia needed until in non-lung recovery cases?

Answer 11

Until the proximal aorta is clamped —> after ventilator, IVs and cardiac monitor can be d/c’ed

Question 12

Why is anesthesia needed post proximal aorta clamp if lungs are being recovered?

Answer 12

To hyperventilate the lungs to ensure perfusion at cellular level

Question 13

Donor support is necessary for recovery of viable organs, what are basic stats to ensure this?

Answer 13

1. BP > 100 mmHg systolic and/or CVP 8-12 mmHg
2. O2 sats > 96%
3. Urine output > 100 mL/hour (volume expansion with colloids & crystalloids)

Question 14

Anesthesia is not required for donor surgery, what may be needed and why?

Answer 14

Muscle relaxant to neutralize spinal reflexes & relax abdomen

Question 15

What are frequently required meds for donor surgery? (8)

Answer 15

1. 6-8 liters LR
2. Pavulon/vecuronium
3. Heparin 30,000 units
4. Thyroxine drip
5. Pressor s (DA, neo, Levo, vasopressin)
6. Albumin
7. Mannitol
8. Lasix

Question 16

How should PRBCs be handled for donor cases for 1. Extrarenal donors, and 2. SPLIT liver?

Answer 16

1. Extrarenal donors should have units of PRBCs on HOLD

2. SLIT livers should have 2 (+) units IN OR!

Question 17

What are the 2 major indications for kidney transplant?

Answer 17

1. DM
2. HTN (nephropathy)
   Glomerulonephritis
   Polycystic kidney disease

Question 18

Why are kidney tx pts likely to be anemic prior to transplant?

Answer 18

Decreased erythropoietin production and hemolysis —> body compensates by increased CO to compensate for ischemia

Question 19

Kidney failure pts often have coagulopathies, what can be given?

Answer 19

1. Decompression (Incr. VWf & DI = incr. ADH)

2. Cryo

Question 20

T/F: Diabetic autonomic neuropathy can make intra-op BP control difficult

Answer 20

True

Question 21

What 2 things specific to diabetics (often kidney tx pts) make you concerned regarding their airway?

Answer 21

1. Gastroparesis = increased r/o aspiration

2. Stiff joint syndrome (decreased ROM at Atlanta occipital joint)

Question 22

What negative effects does Stiff Joint Syndrome have for anesthesia? What type of pts often have this?

Answer 22

1. Difficult intubation (decreased ROM at Atlanto-occipital joint)
2. Impaired respiratory function (decreased elastic properties = restricted lung volumes, decreased Vt, decreased forced expiratory volume and decreased cough)