Pancreas transplant

Pancreas transplant

Anesthesia type	General
Airway	ETT
Lines and access	2-3 PIV, 16-18 G, Arterial Line
Monitors	Standard, 5 lead ECG
Primary anesthetic considerations
Preoperative
Intraoperative	Labile Glycemia -insulin and glucose may be needed in the same patient. Heparin should be prepared and may be sued before clamping of the iliac A or V before pancreatic anastomosis. Intraop immunosuppression should be running before Thymoglobulin or Simulect and prior to reperfusion.
Postoperative
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Pancreas transplantation is performed in one of the following three settings (in decreasing order of frequency): Simultaneous pancreas and kidney transplant (SPK) Pancreas after kidney transplant (PAK) Pancreas transplant alone (PTA).

Preoperative management

Patient evaluation

The recipients are patients with longstanding type 1 diabetes(juvenile onset) and therefore have issues related to long term glucose intolerance.

System	Considerations
Airway	Incidence of difficult intubation is somewhat increased in this patient population due to limited mobility of the cervical spine or temporomandibular joint.
Neurologic	autonomic nervous system dysfunction, systemic and peripheral neuropathy
Cardiovascular	CAD is common in this population
Gastrointestinal	gastroparesis
Renal	Renal insufficiency
Endocrine	Insulin dependence is likely in this population. Favorable peri-operative glycemic control and pre-operative glucose assessment is necessary. Pre-operative NPO status requires insulin adjustments.
Other

Labs and studies

• CBC
• CMP

Operating room setup

• Prepare arterial line
• Have heparin in the room
• May need steroid and/or anti-thymocyte globulin prepared

Procedure variants

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