Difference between revisions of "Organ procurement"
From WikiAnesthesia
| Line 9: | Line 9: | ||
}} | }} | ||
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 == | ||
| Line 60: | Line 60: | ||
=== 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. --> === | ||
| Line 87: | Line 93: | ||
* 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. --> === | ||
Latest revision as of 14:49, 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. 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
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
- 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
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 ~15 min prior to aortic cross clamp
- High dose of heparin (e.g. 30,000 units) is used immediately 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