Menu Expand
Transplantation, An Issue of Anesthesiology Clinics, E-Book

Transplantation, An Issue of Anesthesiology Clinics, E-Book

Aman Mahajan | Christopher Wray

(2017)

Additional Information

Book Details

Abstract

This issue of Anesthesiology Clinics focuses on Transplantation. Editors Aman Mahajan and Christopher Wray have assembled an expert team of authors on topics such as: Immunology and Pharmacology of Transplantation; Infectious Diseases and Malignancies in Transplantation; Anesthesia Management of the Organ Donor; Transfusion Medicine and Coagulation Management in Organ Transplantation; Pediatric Transplantation; Anesthesia for Kidney and Pancreas Transplantation; Anesthesia for Heart Transplantation; Anesthesia for Lung Transplantation; Anesthesia for Liver Transplantation; Anesthesia for Small Bowel and Multivisceral Transplantation; Anesthesia for hand and face transplantation; Anesthesia considerations in Transplant recipients for Non-transplant surgery.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Transplantation\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Foreword: Transplantation Anesthesia: The Role of the Anesthesiologist vii
Preface: Organ Transplantation: A Systematic Review vii
Overview of Immunosuppressive Therapy in Solid Organ Transplantation vii
Infectious Complications and Malignancies Arising After Liver Transplantation vii
Anesthesia Management of Organ Donors vii
Transfusion Medicine and Coagulation Management in Organ Transplantation viii
Anesthetic Management of Pediatric Liver and Kidney Transplantation viii
Anesthesia for Kidney and Pancreas Transplantation viii
Anesthesia for Heart Transplantation viii
Anesthesia for Lung Transplantation ix
Anesthesia for Liver Transplantation ix
Anesthesia for Intestinal Transplantation ix
Anesthesia and Perioperative Care in Reconstructive Transplantation ix
Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery x
ANESTHESIOLOGY CLINICS\r xi
FORTHCOMING ISSUES xi
December 2017 xi
March 2018 xi
June 2018 xi
RECENT ISSUES xi
June 2017 xi
March 2017 xi
December 2016 xi
Foreword:\rTransplantation Anesthesia: The Role of the Anesthesiologist xiii
Preface:\rOrgan Transplantation: A Systematic Review xv
Overview of Immunosuppressive Therapy in Solid Organ Transplantation 365
Key points 365
INTRODUCTION 365
TRANSPLANT IMMUNOLOGY 366
RECOGNITION 366
PROCESSING 366
MECHANISMS OF TARGET CELL DESTRUCTION 366
PREEXISTING SENSITIZATION 367
CHRONIC REJECTION 367
IMMUNOSUPPRESSIVE STRATEGIES 367
COMMONLY USED IMMUNOSUPPRESSIVE AGENTS 368
Corticosteroids 368
INHIBITORS OF T-CELL PROLIFERATION 369
Mycophenolic Acids (Mycophenolate Mofetil and Myfortic) 369
Mycophenolic acid sodium 370
CALCINEURIN INHIBITORS 370
Cyclosporine 370
Tacrolimus 372
INHIBITORS OF LATE T-CELL FUNCTION 373
Mammalian Target of Rapamycin Inhibitors 373
Sirolimus 373
Everolimus 373
INTERLEUKIN 2 RECEPTOR ANTAGONISTS 373
Basiliximab 373
POLYCLONAL ANTIBODIES 374
Antithymocyte Globulin 374
MONOCLONAL ANTIBODIES 374
Alemtuzumab 374
Rituximab 375
OTHER AGENTS 375
Bortezomib 375
Eculizumab 375
Costimulation Blockade 375
SUMMARY 375
REFERENCES 376
Infectious Complications and Malignancies Arising After Liver Transplantation 381
Key points 381
INTRODUCTION 381
INFECTIOUS COMPLICATIONS 382
EARLY BACTERIAL INFECTIONS 382
INTERMEDIATE AND LATE BACTERIAL INFECTIONS 383
VIRAL INFECTIONS 384
HERPES VIRUSES 384
HEPATITIDES RELEVANT TO LIVER TRANSPLANTATION 384
Hepatitis B 384
Hepatitis C 385
COMMON FUNGAL INFECTIONS IN LIVER TRANSPLANTATION 385
Candida Species 386
Aspergillus Species 386
MALIGNANCIES ASSOCIATED WITH LIVER TRANSPLANTATION 387
Dermatologic Cancers 387
Hematologic Cancers 387
Hepatocellular Carcinoma Recurrence 388
DIFFERENCES IN POSTTRANSPLANT INFECTIONS AND MALIGNANCIES BETWEEN LIVER AND KIDNEY TRANSPLANT RECIPIENTS 388
SUMMARY 389
REFERENCES 389
Anesthesia Management of Organ Donors 395
Key points 395
INTRODUCTION 395
MANAGEMENT OF ORGAN DONORS BEFORE PROCUREMENT 396
Cardiovascular 397
Respiratory 397
Renal 397
Endocrine and Hormone 398
Temperature 398
Metabolic and Others 398
Donors with Extended Criteria 398
Organs from Donation After Cardiac Death 399
Standardized Donor Management 399
MANAGEMENT OF ORGAN DONORS DURING PROCUREMENT SURGERY 400
MANAGEMENT OF BRAIN-DEAD ORGAN DONORS 400
MANAGEMENT OF LIVING ORGAN DONORS 400
LIVING KIDNEY DONOR 401
LIVING LIVER DONOR 401
MANAGEMENT OF DONATED GRAFTS AFTER PROCUREMENT 402
REFERENCES 403
Transfusion Medicine and Coagulation Management in Organ Transplantation 407
Key points 407
INTRODUCTION 407
HEMORRHAGE 408
MONITORING AND DECISION MAKING 410
Rotational Thromboelastometry Values 411
Liver 413
CARDIOTHORACIC 416
KIDNEY 416
SMALL BOWEL 416
COMPOSITE TISSUE ALLOTRANSPLANTATION 417
REFERENCES 417
Anesthetic Management of Pediatric Liver and Kidney Transplantation 421
Key points 421
INTRODUCTION 421
PEDIATRIC LIVER TRANSPLANTATION 422
Introduction 422
Indications 422
Absolute Contraindications 423
Preoperative Evaluation 424
Induction and Maintenance of Anesthesia 425
Lines and Monitoring 425
Lines 425
Arterial access 426
Central access 426
Monitoring 426
Additional monitors and devices 426
Transesophageal echocardiography 426
Continuous renal replacement therapy 426
Pulmonary artery catheter 427
Intraoperative Management 427
Stages of liver transplantation 427
Preanhepatic phase 427
Anhepatic phase 427
Reperfusion 428
Neohepatic phase 428
Perioperative extubation 429
PEDIATRIC KIDNEY TRANSPLANTATION 430
Epidemiology and Overview 430
Pathophysiology of End-Stage Renal Disease and Preoperative Evaluation 430
Surgical Considerations and Techniques 431
Anesthetic Management 432
Anesthetic choice 432
Monitoring and vascular access 432
Induction 433
Maintenance 433
Fluid management 433
Hemodynamic goals 434
Diuretics 434
Emergence 434
OUTCOMES 435
SUPPLEMENTARY DATA 435
REFERENCES 435
Anesthesia for Kidney and Pancreas Transplantation 439
Key points 439
INTRODUCTION 439
RENAL TRANSPLANTATION 440
Epidemiology 440
Eligibility for Transplant 440
Preoperative Evaluation 440
Preoperative Dialysis 441
Living Versus Deceased Organ Donation 442
Organ Acceptance and Retrieval Considerations 442
Intraoperative Anesthetic Considerations 443
Intraoperative Fluid Management 444
Intraoperative Vasoactive Drugs 445
Intraoperative Renal Protection 446
Complications 446
PANCREAS TRANSPLANTATION 447
Epidemiology 447
Eligibility for Transplant 447
Preoperative Evaluation 447
Intraoperative Management 448
Complications 448
Islet Cell Transplantation 449
REFERENCES 449
Anesthesia for Heart Transplantation 453
Key points 453
INTRODUCTION AND HISTORY 453
RECIPIENT SELECTION 456
DONOR SELECTION 459
VENTRICULAR ASSIST DEVICES 460
PREANESTHETIC CONSIDERATIONS 461
INDUCTION AND MAINTENANCE 462
Monitoring 463
Transesophageal Echocardiography 463
Induction 463
Ventilation 464
MAINTENANCE 464
Before Cardiopulmonary Bypass 465
Weaning from Cardiopulmonary Bypass 465
MANAGEMENT AFTER CARDIOPULMONARY BYPASS 466
REFERENCES 467
Anesthesia for Lung Transplantation 473
Key points 473
INTRODUCTION 473
INDICATIONS FOR LUNG TRANSPLANTATION AND PATIENT SELECTION 474
PERIOPERATIVE CONSIDERATIONS 475
Preoperative Assessment 475
Preinduction 478
Induction 478
Surgical Aspects and Maintenance of Anesthesia 479
Ventilation Strategies of the Transplanted Lungs 481
Inhaled Pulmonary Vasodilators After Lung Transplantation 482
Transesophageal Echocardiography During Lung Transplantation 483
Fluid Management During Lung Transplantation 485
Other Anesthetic Considerations 486
ROLE OF EXTRACORPOREAL MECHANICAL SUPPORT IN LUNG TRANSPLANTATION 486
POSTOPERATIVE PAIN MANAGEMENT 486
SUMMARY 487
REFERENCES 487
Anesthesia for Liver Transplantation 491
Key points 491
LIVER: BASIC ANATOMY AND PHYSIOLOGY 491
LIVER DISEASE: PATHOPHYSIOLOGY 492
Liver Cirrhosis 492
TRANSPLANT SELECTION COMMITTEE 493
PREOPERATIVE ASSESSMENT 494
CENTRAL NERVOUS SYSTEM: HEPATIC ENCEPHALOPATHY AND ACUTE LIVER FAILURE 494
THE CARDIOVASCULAR SYSTEM 495
Cirrhotic Cardiomyopathy 495
Primary Cardiac Disease 495
Coronary artery disease 495
Preoperative Cardiac Assessment 497
PULMONARY SYSTEM 497
Hepatic Hydrothorax 497
THE RENAL SYSTEM 499
THE COAGULATION SYSTEM 500
ANESTHESIA MANAGEMENT 502
POSTOPERATIVE COURSE 504
REFERENCES 505
Anesthesia for Intestinal Transplantation 509
Key points 509
INTESTINAL FAILURE AND PARENTERAL NUTRITION DEPENDENCY 509
INDICATIONS FOR INTESTINAL TRANSPLANTATION 511
PREOPERATIVE EVALUATION AND LISTING 512
TYPES OF INTESTINAL ALLOGRAFTS 513
Isolated Intestine Allografts 513
Liver–Intestine Allografts 513
Multivisceral and Modified Multivisceral Allografts 514
Living Donor Intestine Allografts 514
INDUCTION IMMUNOSUPPRESSION 514
CONDUCT OF INTESTINAL TRANSPLANTATION 514
ANESTHETIC MANAGEMENT 515
PEDIATRIC MANAGEMENT 517
OUTCOMES AND POSTOPERATIVE COMPLICATIONS 518
SUMMARY 518
ACKNOWLEDGMENTS 518
REFERENCES 518
Anesthesia and Perioperative Care in Reconstructive Transplantation 523
Key points 523
RECONSTRUCTIVE TRANSPLANTATION 524
ANESTHESIA IN RECONSTRUCTIVE TRANSPLANTATION 524
THE PERIOPERATIVE IMMUNE RESPONSE IN RECONSTRUCTIVE TRANSPLANTATION 525
Peritransplant Immunosuppression 526
Induction therapies 526
Depleting agents 526
Nondepleting agents 527
Immunomodulatory Protocols 527
KEY PERIOPERATIVE ANESTHETIC CONSIDERATIONS 527
ANESTHETIC PROCEDURES AND PROTOCOLS: PEARLS AND PITFALLS 528
MISCELLANEOUS RECOMMENDATIONS 532
Blood Loss 532
Intravascular and Airway Access 532
Coagulation Monitoring 533
Pulmonary Protection 533
Sepsis Prevention 533
Preventing Regional Vasoconstriction 533
Pain Management 533
FUTURE DIRECTIONS 533
REFERENCES 534