Difference between revisions of "Heart transplant"
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== Intraoperative management == | == 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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | === 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. --> === | ||
Latest revision as of 09:36, 30 January 2024
Heart transplant
| Anesthesia type | |
|---|---|
| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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 |