Organ procurement - Revision history

Tony.Wang at 22:49, 24 December 2023

2023-12-24T22:49:19Z

← Older revision		Revision as of 15:49, 24 December 2023
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	}}		}}

	An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation.		An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation. The anesthetic plan is simple, but there can be a lot of nuance depending on the organs being procured and the needs of the surgical team.

	== Overview ==		== Overview ==
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	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===		=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

			* Fluids: crystalloid and albumin for volume repletion
			* Pressors and dilators for tight BP control
			* Diuretics: mannitol (e.g. 25 g) and furosemide (e.g. 40 mg) are typically requested by surgeons
			* Steroid (e.g. methylprednisolone 1000 mg)
			* Anticoagulation with heparin for aortic cross clamp

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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	* Careful hemodynamic control is needed. Have vasopressors and vasodilators available		* Careful hemodynamic control is needed. Have vasopressors and vasodilators available
	* Complete paralysis		* Complete paralysis
	* Mannitol and furosemide may be requested		* Mannitol and furosemide may be requested ~15 min prior to aortic cross clamp
	* High dose of heparin (e.g. 30,000 units) is used prior to aortic cross clamp		* High dose of heparin (e.g. 30,000 units) is used immediately prior to aortic cross clamp

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

Tony.Wang at 22:29, 24 December 2023

2023-12-24T22:29:30Z

← Older revision		Revision as of 15:29, 24 December 2023
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	=== Indications<!-- List and/or describe the indications for this surgical procedure. --> ===		=== Indications<!-- List and/or describe the indications for this surgical procedure. --> ===
			Procurement of organs following brain death or cardiac death

	=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===		=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===

			* Variable based on which organs are being recovered
			* Generally, includes a subxyphoid-to-pubis incision +/- sternotomy

	== Preoperative management ==		== Preoperative management ==
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	\|-		\|-
	\|Airway		\|Airway
	\|		\|Should already be mechanically ventilated
	\|-		\|-
	\|Neurologic		\|Neurologic
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	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\|Maintaining organ perfusion pressure is crucial. Patients are typically on multiple vasopressors
	\|-		\|-
	\|Pulmonary		\|Pulmonary
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	\|-		\|-
	\|Renal		\|Renal
	\|		\|Brain dead patients can develop diabetes insipidus and may require vasopressin
	\|-		\|-
	\|Endocrine		\|Endocrine
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	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
			Different hospital institutions may have special traditions that are done for the family of the donor.

	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
			N/A

	== Intraoperative management ==		== Intraoperative management ==

	=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===		=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===

			* Standard ASA monitors
			* Arterial line for close hemodynamic monitoring to ensure appropriate organ perfusion

	=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===		=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===

			* Generally no induction of anesthesia is needed
			* Patient should be adequately oxygenated to avoid hypoxia to organs

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
			Supine

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===

			* No anesthesia is needed
			* Careful hemodynamic control is needed. Have vasopressors and vasodilators available
			* Complete paralysis
			* Mannitol and furosemide may be requested
			* High dose of heparin (e.g. 30,000 units) is used prior to aortic cross clamp

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
			Once organs are accepted and have arrangements for delivery, aorta is cross clamped and organ procurement commences. Anesthesiology is not needed after aortic cross-clamp.

	== Postoperative management ==		== Postoperative management ==

	=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===		=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
			N/A

	=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===		=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
			N/A

	=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===		=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===

Tony.Wang: Created page with "{{Infobox surgical procedure | anesthesia_type = None required typically | airway = ETT | lines_access = PIV, arterial line | monitors = Standard, ABP | considerations_preoperative = | considerations_intraoperative = No anesthesia required. Hemodynamic control and volume status may be adjusted per surgeons | considerations_postoperative = }} An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation. ==..."

2023-12-24T20:43:03Z

Created page with "{{Infobox surgical procedure | anesthesia_type = None required typically | airway = ETT | lines_access = PIV, arterial line | monitors = Standard, ABP | considerations_preoperative = | considerations_intraoperative = No anesthesia required. Hemodynamic control and volume status may be adjusted per surgeons | considerations_postoperative = }} An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation. ==..."

New page

{{Infobox surgical procedure
| anesthesia_type = None required typically
| airway = ETT
| lines_access = PIV, arterial line
| monitors = Standard, ABP
| considerations_preoperative =
| considerations_intraoperative = No anesthesia required. Hemodynamic control and volume status may be adjusted per surgeons
| considerations_postoperative =
}}

An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation.

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===

=== Induction and airway management ===

=== Positioning ===

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===

=== Pain management ===

=== Potential complications ===

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Indications
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]