Difference between revisions of "Heart transplant"

Heart transplant
Anesthesia type
Airway
Lines and access
Monitors
	Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
	Article quality
Editor rating	Unrated
User likes	0

VisualWikitext

Latest revision as of 09:36, 30 January 2024

Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation


System	Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Operating room setup

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

All are General Recommendations and Considerations. Your comfortability, Surgeons, and hospital policies and practices will dictate the plan.

Monitoring and access

Large bore IV (18-gauge) placed in Pre-op. Can use this IV line to go to induce anesthesia and give pre-op medications.

Arterial Access:

Awake vs asleep Arterial Line, typically a radial arterial line. Surgeons may elect to place femoral arterial lines as well.

Vascular Access:

Once asleep: additional large bore access should be obtained: there is variation in practice here:

Double Stick right Internal Jugular
- Cordis 8.5F for large volume resuscitation and blood products
- Single or double lumen 16g Central line for infusions
Single Stick RIJ
- Cordis 8.5F or 9F
- 14 G or 16 G peripheral IV's
Consider Triple stick, RIC line and additional access, especially for redo-sternotomy cases

Central monitoring:

CVP monitoring
Swan-ganz catheter placement is not unusual
- Occasionally may be placed after induction but left at only 20cm until the new heart is placed in the chest then floated into the Pulmonary Artery.
- Can be used to measure Cardiac Output and Cardiac index via Thermodilution

Induction and airway management

Positioning

Typically Supine with bilateral Arms tucked at the side.

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants


	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References

Top contributors: Mitchel DeVita, Nicholas Corcoran and Chris Rishel

@@ Line 1: / Line 1: @@
+{{Infobox surgical procedure
+| anesthesia_type =
+| airway =
+| lines_access =
+| monitors =
+| considerations_preoperative =
+| considerations_intraoperative =
+| considerations_postoperative =
+}}
+Provide a brief summary of this surgical procedure and its indications here.
+== Preoperative management ==
+=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+{| class="wikitable"
+|+
+!System
+!Considerations
+|-
+|Neurologic
+|
+|-
+|Cardiovascular
+|
+|-
+|Pulmonary
+|
+|-
+|Gastrointestinal
+|
+|-
+|Hematologic
+|
+|-
+|Renal
+|
+|-
+|Endocrine
+|
+|-
+|Other
+|
+|}
+=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. 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. --> ===
+=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. 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. --> ===
+== Intraoperative management ==
+All are General Recommendations and Considerations. Your comfortability, Surgeons, and hospital policies and practices will dictate the plan.
+=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
+Large bore IV (18-gauge) placed in Pre-op. Can use this IV line to go to induce anesthesia and give pre-op medications.
+'''Arterial Access:'''
+Awake vs asleep Arterial Line, typically a radial arterial line. Surgeons may elect to place femoral arterial lines as well.
+'''Vascular Access:'''
+Once asleep: additional large bore access should be obtained: there is variation in practice here:
+* Double Stick right Internal Jugular
+** Cordis 8.5F for large volume resuscitation and blood products
+** Single or double lumen 16g Central line for infusions
+* Single Stick RIJ
+** Cordis 8.5F or 9F
+** 14 G or 16 G peripheral IV's
+* Consider Triple stick, RIC line and additional access, especially for redo-sternotomy cases
+'''Central monitoring:'''
+* CVP monitoring
+* Swan-ganz catheter placement is not unusual
+** Occasionally may be placed after induction but left at only 20cm until the new heart is placed in the chest then floated into the Pulmonary Artery.
+** Can be used to measure Cardiac Output and Cardiac index via Thermodilution
+=== 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. --> ===
+=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
+Typically Supine with bilateral Arms tucked at the side.
+=== 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. --> ===
+=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
+== Postoperative management ==
+=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
+=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
+=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
+== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
+{| class="wikitable wikitable-horizontal-scroll"
+|+
+!
+!Variant 1
+!Variant 2
+|-
+|Unique considerations
+|
+|
+|-
+|Position
+|
+|
+|-
+|Surgical time
+|
+|
+|-
+|EBL
+|
+|
+|-
+|Postoperative disposition
+|
+|
+|-
+|Pain management
+|
+|
+|-
+|Potential complications
+|
+|
+|}
+== References ==
+[[Category:Surgical procedures]]