Anesthesia for Kidney and Pancreas Transplantation

Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Aaron M. Mittel, Gebhard Wagener

Teaser

Kidney transplants are the most common solid organ abdominal transplant and are occasionally performed simultaneously with pancreas transplants in diabetic patients. Preoperative evaluation of potential transplant recipients should focus on the potential for occult cardiovascular disease while also screening for other signs of end-organ dysfunction. Intraoperatively, it is of utmost importance to ensure adequate graft perfusion to limit the risk of postoperative graft dysfunction or rejection. Postoperative care of the kidney or pancreas transplant patient should focus on ensuring normalization of volume status, electrolyte concentrations, and glycemic control.


from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2tL95RC
via IFTTT

Anesthetic Management of Pediatric Liver and Kidney Transplantation

Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Nicholas R. Wasson, Jeremy D. Deer, Santhanam Suresh

Teaser

Pediatric patients with liver dysfunction and renal failure may exhibit many comorbidities. There are often associated congenital syndromes to be taken into account. Liver and renal transplantation offer a solution and substantial improvement in quality of life. Anesthetic management of pediatric liver and renal transplantation has not been well-described. There are key differences between adults and children undergoing these procedures, and acknowledgment of some key principles provide a solid foundation to optimize perioperative outcomes. This article provides an overview of the perioperative management and considerations in pediatric patients undergoing liver and renal transplantation.


from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2t1K8nU
via IFTTT

Anesthesia for Liver Transplantation

Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Dieter Adelmann, Kate Kronish, Michael A. Ramsay

Teaser

The provision of anesthesia for a liver transplant program requires a dedicated team of anesthesiologists. Liver transplant anesthesiologists must have an understanding of liver physiology and anatomy; the spectrum of clinical disease associated with liver dysfunction; the impact of warm and cold ischemia times, surgical techniques in liver transplantation, the impact of ischemia–reperfusion syndrome; and optimal practices to protect the liver. The team must provide a 24-hour service, be actively involved in the selection committee process, and stay current with advances in the subspecialty.


from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2tL7Fqu
via IFTTT

Transfusion Medicine and Coagulation Management in Organ Transplantation

Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Jaswanth Madisetty, Cynthia Wang

Teaser

Organ transplantation recipients present unusual challenges with regard to blood transfusion. Although this patient population requires a larger proportion of blood product resources, liberal transfusion of allogeneic blood products can lead to a plethora of complications. Recent trends suggest that efforts to minimize bleeding, conserve products, and target transfusion to specific deficits and needs are increasingly becoming the standard practice. This must all occur with optimization of graft function and preservation in mind. With newer monitoring modalities and factor concentrates, the approach toward transfusion and bleeding in organ transplantation has rapidly improved in recent years.


from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2t1Wtsn
via IFTTT

Organ Transplantation: A Systematic Review

Publication date: Available online 10 July 2017
Source:Anesthesiology Clinics
Author(s): Aman Mahajan, Christopher Wray




from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2t1Hz5m
via IFTTT

Using anatomical landmark to avoid phrenic nerve injury during balloon-based procedures in atrial fibrillation patients

Abstract

Purpose

Atrial fibrillation (AF) is an arrhythmia which affects as many as 2.7 million Americans. AF should be treated, because it can lead to a four-to-fivefold increased risk of experiencing a stroke. The American College of Cardiology/American Heart Association guidelines for the treatment of drug refractory and symptomatic paroxysmal AF denote catheter ablation as the standard of care. The newest ablation treatment, cryoballoon, uses a cold balloon tip. The biggest risk factor associated with the cryoballoon ablation is phrenic nerve injury (PNI). The purpose of this study is to measure relevant distances from specific landmarks to the right phrenic nerve (RPN) to create a safe zone for physicians.

Methods

Using 30 cadaveric specimens, we measured laterally from the right superior pulmonary vein orifice (RSPV) to the RPN at the level of the sixth thoracic vertebra and laterally from the lateral border of the sixth thoracic vertebral body (T6) to the RPN. The depth and width of the left atrium (LA) were also measured to establish a cross-sectional area of the LA. The cross-sectional area of the LA was then correlated with the averaged measurements to see if the area of the LA could be a predictor of the location of the RPN.

Results

The average distance from the RPN–RSPV was 9.6 mm (range 4.3–18.8 mm). The average RPN-T6 distance was 30.6 mm (range 13.7–49.9 mm). There was a non-significant trend that suggests as the size of the LA increases, the measured distances also increased.

Conclusion

Using the lateral border of the sixth thoracic vertebra as a landmark, which can be viewed under fluoroscopy during the procedure, physicians can triangulate the distance to the RSPV and determine the approximate position of the RPN. Furthermore, physicians can perform a preoperative echocardiogram to determine the size of the LA to assist in determining the position of the RPN with the hopes of avoiding injury to the RPN.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2uNZgTc
via IFTTT

Fetal Tobacco Smoke Exposure in the Third Trimester of Pregnancy Is Associated with Atopic Eczema/Dermatitis Syndrome in Infancy

Pediatric Allergy, Immunology, and Pulmonology , Vol. 0, No. 0.


from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2tbubXv
via IFTTT