Difference between revisions of "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
	Article quality
Editor rating	Unrated
User likes	0

VisualWikitext

Revision as of 21:56, 5 January 2023

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).

Overview

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

Patient preparation and premedication

Regional and neuraxial techniques

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

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 and Imelda Muller

@@ Line 1: / Line 1: @@
 {{Infobox surgical procedure
-| anesthesia_type =
+| anesthesia_type = General
-| airway =
+| airway = ETT
-| lines_access =
+| lines_access = 2-3 PIV, 16-18 G, Arterial Line
-| monitors =
+| monitors = Standard, 5 lead ECG
 | considerations_preoperative =
-| considerations_intraoperative =
+| considerations_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.
 | considerations_postoperative =
 }}
-Provide a brief summary here.
+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).
 == Overview ==
-=== Indications<!-- List and/or describe the indications for this surgical procedure. --> ===
-=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> ===
 == Preoperative management ==
-=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
+=== Patient evaluation ===
+The recipients are patients with longstanding type 1 diabetes(juvenile onset) and therefore have issues related to long term glucose intolerance.
 {| class="wikitable"
 |+
@@ Line 26: / Line 23: @@
 |-
 |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
-|-
-|Pulmonary
-|
 |-
 |Gastrointestinal
-|
+|gastroparesis
-|-
-|Hematologic
-|
 |-
 |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
@@ Line 53: / Line 44: @@
 |}
-=== 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. --> ===
+=== Labs and studies ===
+* CBC
+* CMP
+=== Operating room setup ===
-=== 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. --> ===
+* Prepare arterial line
+* Have heparin in the room
+* May need steroid and/or anti-thymocyte globulin prepared
 === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===