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Transplant anaesthesia

Eleonora De Martin, Amelia Hessheimer, Ryan Chadha, Gokhan Kabacam, Jeremy Raganayagam, Varvara Kirchner, Marit Kalisvaart, Irene Scalera, Mamatha Bhat, Alan Contreras, Prashant Bhangui
The 24 Joint Annual Congress of the International Liver Transplantation Society (ILTS) in association with European Liver and Intestine Transplant Association (ELITA) and Liver Intensive Care Group of Europe (LICAGE) was held in Lisbon, Portugal from May 23-26, 2018. More than 1200 participants from over 60 countries including surgeons, hepatologists, anesthesiologists and critical care intensivists, radiologists, pathologists, organ procurement personnel and research scientists, came together with the common aim of improving care and outcomes for liver transplant recipients...
November 19, 2018: Transplantation
János Fazakas, Anikó Smudla
One of the most prominent results of our age is organ transplantation, the single treatment option for patients with end-stage organ failure. The success of transplants depends on the donor care, the patient preoperative preassessment, the perioperative care of organ transplantation and aftercare. Successful transplantation therefore requires a prominent level of continuous collaboration between the surgeon, anaesthesiologist, radiologist, internal medicine and hepatologist, laboratory physician and almost all their associates...
November 2018: Orvosi Hetilap
Gabrielle C Musk, Helen Kershaw, Bulang He
Fifty-four pigs ( Sus scrofa, Large White cross) from a commercial pig farm were anaesthetised over a six-year period from October 2011. The procedural stages included initial instrumentation for intra-operative monitoring, laparoscopic nephrectomy, preparation of the kidney graft, orthotopic auto-transplantation by either a laparoscopic approach or an open surgical approach, and ligation of the contralateral ureter. During the evolution and establishment of this pig model multiple refinements were introduced: (1) a heat pad was changed to a circulating warm air blanket; (2) routine administration of anticholinesterase and antimuscarinic drugs for reversal of neuromuscular blockade; (3) a technique for urethral catheterisation was developed; (4) ultrasound guidance for placement of a central venous line was learned; (5) intravenous infusions of morphine and ketamine were instituted for a more stable and balanced anaesthetic protocol; and (6) post-operative monitoring was performed by two technical staff for at least the first six hours after extubation of the trachea...
October 22, 2018: Laboratory Animals
Aslı Demir, Eda Balcı, Ümit Karadeniz
In this manuscript, we describe a significant advantage of the intraoperative near infrared spectroscopic techniques (NIRS) using in a malignant hypertensive patient during kidney transplantation. This patient underwent operation becasue of the presence of a suitable cadaveric kidney. Moreover, although the patient's hypertension was intensively treated by cardiology for a long time, it could not be controlled. Thus, despite severe hypertension, the patient was anaesthetized. Mean arterial pressures of about 70-90 mmHg, which are considered to be normal for most people, could cause cerebral hypoperfusion in such a patient...
August 2018: Turkish Journal of Anaesthesiology and Reanimation
Lisa Rancan, Carlos Simón, Guillermo Sánchez Pedrosa, Karen Aymonnier, Priya M Shahani, Javier Casanova, Celia Muñoz, Ignacio Garutti, Elena Vara
PURPOSE: Ischaemia-reperfusion injury (IRI) is a main cause of morbidity after pulmonary resection surgery. The degradation of glycocalyx, a dynamic layer of macromolecules at the luminal surface of the endothelium, seems to participate in tissue dysfunction after IRI. Lidocaine has a proven anti-inflammatory activity in several tissues but its modulation of glycocalyx has not been investigated. This work aimed to investigate the potential involvement of glycocalyx in lung IRI in a lung auto-transplantation model and the possible effect of lidocaine in modulating IRI...
2018: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
Zhaosheng Jin, Ornella Piazza, Daqing Ma, Giuliana Scarpati, Edoardo De Robertis
Xenon is a colourless and odourless noble gas, licensed for human use as an anaesthetic gas as well as a radiological marker. The MAC of this gas is about 63% but Xenon anaesthesia is associated with fast recovery of cognitive function and cardiovascular stability. Nevertheless, Postoperative nausea and vomiting (PONV) incidence for xenon anaesthesia is very high. Xenon has been reported to have cytoprotective effects that may have therapeutic values in both CNS protection, and in organ graft preservation. Currently, there are few studies about the effect of Xenon on ischaemia reperfusion injury of transplantable organs and insufficient clinical data upon its effect on intracranial and cerebral perfusion pressure...
July 17, 2018: Minerva Anestesiologica
Gertrude J Nieuwenhuijs-Moeke, Tamar A J van den Berg, Stephan J L Bakker, Marius C van den Heuvel, Michel M R F Struys, Ton Lisman, Robert A Pol
To prevent renal graft thrombosis in kidney transplantation, centres use different perioperative anticoagulant strategies, based on various risk factors. In our centre, patients transplanted preemptively are considered at increased risk of renal graft thrombosis compared to patients who are dialysis-dependent at time of transplantation. Therefore these patients are given a single dose of 5000 IU unfractionated heparin intraoperatively before clamping of the vessels. We questioned whether there is a difference in haemostatic state between preemptively and non-preemptively transplanted patients and whether the distinction in intraoperative heparin administration used in our center is justified...
2018: PloS One
Valentina Assenzo, Cristina Assenzo, Rosalinda Filippo, Morgan Le Guen, Edouard Sage, Antoine Roux, Marc Fischler, Ngai Liu
<AbstractText Label="OBJECTIVES" NlmCategory="OBJECTIVE">We introduced an extubation strategy for emphysema patients after bilateral lung transplantation. Patients who met the extubation criteria were extubated in the operating room (OR) followed by non-invasive ventilation, and the other patients were extubated in the intensive care unit (ICU). The primary objective was to determine the extubation rate. The secondary outcomes were to determine the factors allowing for extubation in the OR and the postoperative course...
December 1, 2018: European Journal of Cardio-thoracic Surgery
S Churchill, L de Lloyd, H C Francis, H Wallis
Heterotopic heart transplants were introduced in 1974. The technique allows the patient's native heart to be preserved in situ, alongside the transplanted heterotopic donor heart. We present the case of a nulliparous woman who underwent heterotopic heart transplant in infancy, and subsequent explantation of the donor heart eleven years later, when her native heart function recovered. In adulthood the patient attended pre-pregnancy counselling and was awaiting cardiac magnetic resonance imaging when she presented pregnant at 6 weeks-of-gestation...
August 2018: International Journal of Obstetric Anesthesia
Hye-Mee Kwon, In-Gu Jun, JungBok Lee, Young-Jin Moon, Kyeo-Woon Jung, Hye-Won Jeong, Yong-Seok Park, Jun-Gol Song, Gyu-Sam Hwang
Desensitisation with therapeutic plasma exchange (TPE) is essential for ABO-incompatible (ABO-I) liver transplants (LTs). However, excessive citrate load and coagulation disturbances after TPE have been poorly studied, in particular in cirrhotic patients with hypocapnic alkalosis, metabolic compensation and electrolyte imbalances. We retrospectively evaluated 1123 consecutive LT recipients (923 ABO-compatible [ABO-C], 200 ABO-I) from November 2008 to May 2015. TPE was generally performed a day before LT and blood sampling was performed before anaesthesia induction...
April 27, 2018: Scientific Reports
B A Rivas Rivero, A Mira Puerto, J Cuenca
The case is presented of a post-lung transplant patient, ASA III, proposed for orchiectomy due to testicular cancer. A combination of iliohypogastric (ILH), ilioinguinal (ILI) and genitofemoral (GF) nerve block together with sedation was used as anaesthetic technique. The inguinal area received sensory innervation mainly from ILI, ILH and GF nerves. The genital branch of the GF nerve supplies innervation to skin of the anterosuperior portion of the scrotum. When performing the echo-guided block of GF nerve, it is necessary to identify the spermatic cord, and administer the local anaesthetic on the inside and periphery of the cord...
April 2, 2018: Revista Española de Anestesiología y Reanimación
S Perez-Protto, R Nazemian, M Matta, P Patel, K J Wagner, S Q Latifi, D J Lebovitz, J D Reynolds
Many deceased by neurologic criteria donors are administered inhalational agents during organ recovery surgery-a process that is characterised by warm and cold ischaemia followed by warm reperfusion. In certain settings, volatile anaesthetics (VA) are known to precondition organs to protect them from subsequent ischaemia-reperfusion injury. As such, we hypothesised that exposure to VA during organ procurement would improve post-graft survival. Lifebanc (organ procurement organisation [OPO] for NE Ohio) provided the investigators with a list of death by neurologic criteria organ donors cared for at three large tertiary hospitals in Cleveland between 2006 and 2016-details about the surgical recovery phase were extracted from the organ donors' medical records...
March 2018: Anaesthesia and Intensive Care
Awy Chua, M J Chua, Pca Kam
Significant surgical advances have been made recently in corneal transplantation. Penetrating keratoplasty was the dominant method from 1905, until selective lamellar keratoplasty emerged as the preferred technique over the last 20 years. Advanced techniques such as corneal limbal stem cell transplant and keratoprosthesis are also available. The major surgical complications of corneal transplantation are extrusion of ocular content and expulsive choroidal haemorrhage. It is essential for an ophthalmic anaesthetist to have a good understanding of these new surgical procedures so as to provide optimal surgical conditions...
March 2018: Anaesthesia and Intensive Care
Valter Perilli, Paola Aceto, Teresa Sacco, Pierpaolo Ciocchetti, Domenico Papanice, Carlo Lai, Liliana Sollazzi
BACKGROUND: The role of post-reperfusion lactate clearance in assessing graft function has not yet been investigated. The aim of this study was to examine whether lactate clearance, assessed in the post-reperfusion phase, can predict poor graft function in liver transplant patients. METHODS: Seventy patients undergoing liver transplantation (LT) were enrolled. Standardised anaesthesia and intraoperative monitoring were applied. The lactate level measured immediately after venous reperfusion and 6 hours later were used to calculate lactate clearance by the following formula: [(reperfusion lactate - 6h post-reperfusion lactate)/reperfusion lactate] ×100...
February 5, 2018: Minerva Anestesiologica
Xingyu Wang, Roumen Parapanov, Cyril Francioli, Jean Yannis Perentes, Igor Letovanec, Michel Gonzalez, Christian Kern, Hans-Beat Ris, Lise Piquilloud, Carlo Marcucci, Thorsten Krueger, Lucas Liaudet, Fabrizio Gronchi
OBJECTIVES: Volatile anaesthetics can provide significant protection against reperfusion injury in various experimental settings. The aim of this study was to assess the potential of sevoflurane treatment, the most commonly used volatile anaesthetic in modern anaesthesia, in rat lungs donated after circulatory death and reconditioned in an ex vivo lung perfusion (EVLP) system. METHODS: Fifteen rats were sacrificed and divided into 3 groups. In the control and sevoflurane groups, the heart-lung blocks were exposed to 1 h of warm ischaemia and 2 h of cold ischaemia and were mounted on an EVLP circuit for 3 h, in the absence or in the presence of 2% sevoflurane...
June 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Daisuke Taniguchi, Keitaro Matsumoto, Tomoshi Tsuchiya, Ryusuke Machino, Yosuke Takeoka, Abdelmotagaly Elgalad, Kiyofumi Gunge, Katsunori Takagi, Yasuaki Taura, Go Hatachi, Naoto Matsuo, Naoya Yamasaki, Koichi Nakayama, Takeshi Nagayasu
OBJECTIVES: Currently, most of the artificial airway organs still require scaffolds; however, such scaffolds exhibit several limitations. Alternatively, the use of an autologous artificial trachea without foreign materials and immunosuppressants may solve these issues and constitute a preferred tool. The rationale of this study was to develop a new scaffold-free approach for an artificial trachea using bio-3D printing technology. Here, we assessed the circumferential tracheal replacement using scaffold-free trachea-like grafts generated from isolated cells in an inbred animal model...
May 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Andrie C Westerkamp, A Fred de Geus, Bouwe Molenbuur, Peter Meyer, J K Götz Wietasch, Michel M R F Struys, Herman G D Hendriks
BACKGROUND: Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE: The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery...
April 2018: European Journal of Anaesthesiology
F Simonacci, M P Grieco, N Bertozzi, E Raposio
BACKGROUND: Autologous fat transplantation is used after breast reconstruction to improve the breast profile. There are a variety of different methods used for fat harvesting, preparation, and reinjection. This study describes the specific techniques we used in this series of autologous fat transplantations in breast reconstruction patients and reports their outcomes compared with other studies in the literature. PATIENTS AND METHODS: At the University Hospital of Parma between May 2012 and December 2016, we performed 53 autologous fat transplantations for secondary breast reconstruction patients with an average age of 49 years (range: 34-65 y)...
May 2017: Il Giornale di Chirurgia
Sivaramakrishnan Venkatesh Karthik, Seng-Hock Quak, Marion M Aw
The published paediatric experience with endoscopic retrograde cholangio-pancreatography (ERCP) in the diagnosis and management of biliary complications following liver transplantation (LT) is limited. We describe our experience with ERCP in the management of children following LT who presented with biliary complications, over a 20-year period (1995-2014). The retrospectively reviewed data are summarized descriptively. Of 94 children (47 boys) who received 102 liver transplants at our centre, seven children (five boys, two girls) underwent ERCP after liver transplantation...
March 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
L Zhao, L L Ma, H X Zhang, X F Hou, L Liu, Y Fu, Y G Kou, Y M Song
OBJECTIVE: To summarize our experience of retroperitoneal laparoscopic living donor nephrectomy, our continuous technical improvements and refinement of this skill and standardization of each procedure of this operation. METHODS: Having approved by hospital ethical committee and local government administration, a total of 193 living donors underwent retroperitoneal laparoscopic living donor nephrectomy from Dec.2003 to Feb. 2016 in our department. Under general anaesthesia, the operation was performed through 3 lumbar ports...
October 18, 2017: Beijing da Xue Xue Bao. Yi Xue Ban, Journal of Peking University. Health Sciences
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