Difference between revisions of "Organ procurement"
From WikiAnesthesia
(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. ==...") |
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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 == | ||
| Line 26: | Line 30: | ||
|- | |- | ||
|Airway | |Airway | ||
| | |Should already be mechanically ventilated | ||
|- | |- | ||
|Neurologic | |Neurologic | ||
| Line 32: | Line 36: | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Maintaining organ perfusion pressure is crucial. Patients are typically on multiple vasopressors | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| Line 44: | Line 48: | ||
|- | |- | ||
|Renal | |Renal | ||
| | |Brain dead patients can develop diabetes insipidus and may require vasopressin | ||
|- | |- | ||
|Endocrine | |Endocrine | ||
| Line 58: | Line 62: | ||
=== 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. --> === | ||
Revision as of 14:29, 24 December 2023
Organ procurement
| Anesthesia type |
None required typically |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV, arterial line |
| Monitors |
Standard, ABP |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative |
No anesthesia required. Hemodynamic control and volume status may be adjusted per surgeons |
| Postoperative | |
| Article quality | |
| Editor rating | |
| User likes | 0 |
An organ procurement is performed on a patient who is clinically deceased in order to harvest organ(s) for transplantation.
Overview
Indications
Procurement of organs following brain death or cardiac death
Surgical procedure
- Variable based on which organs are being recovered
- Generally, includes a subxyphoid-to-pubis incision +/- sternotomy
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Should already be mechanically ventilated |
| Neurologic | |
| Cardiovascular | Maintaining organ perfusion pressure is crucial. Patients are typically on multiple vasopressors |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | Brain dead patients can develop diabetes insipidus and may require vasopressin |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Different hospital institutions may have special traditions that are done for the family of the donor.
Regional and neuraxial techniques
N/A
Intraoperative management
Monitoring and access
- Standard ASA monitors
- Arterial line for close hemodynamic monitoring to ensure appropriate organ perfusion
Induction and airway management
- Generally no induction of anesthesia is needed
- Patient should be adequately oxygenated to avoid hypoxia to organs
Positioning
Supine
Maintenance and surgical considerations
- 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
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
Disposition
N/A
Pain management
N/A
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Tony Wang