Anesthetic and perioperative management of intestinal and multivisceral allograft recipient in nontransplant surgery

Abstract

Summary As the survival rate of the intestinal and multi‐visceral transplant recipients continues to improve, an increasing number of these patients present for either elective or emergency surgery related or unrelated to transplantation. The aim of this review is to focus on clinical issues related to the anesthetic and perioperative management of the intestinal or multi‐visceral transplant recipient for nontransplant surgery. Specific issues concerning perioperative assessment and medications, choice of anesthetic drugs and techniques, and postoperative care management are reviewed.

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“…Infection is a major cause of morbidity and the most common cause of death in liver-graft recipients. 3,5 Postoperative infection was observed in 7% of our recipients.…”

The Anesthetic Management of Adult Patients with Organ Transplants Undergoing Nontransplant Surgery

“…Superior analgesia over systemic opioids, especially in patients who may have narcotics tolerance as a result of long-term opioid use, reduced pulmonary complications, decreased incidence of graft occlusion, and improved joint mobility are just a few of the benefits of regional and neuraxial anesthesia [29]. Clinically relevant doses of bupivicaine and ropiviciane, which are commonly used local anesthetics for neuraxial anesthesia, do not seem to result in toxic levels or increased risk of toxic effects in renal and liver transplant recipients [8,14]. However, it is important to be prepared for the risk of hypotension because of preexisting autonomic neuropathy and cardiac denervation in this population when performing a neuraxial anesthetic [9,29].…”

“…It is important to consider that central venous access may be difficult as many of these patients have had long-standing illnesses with the need for central venous catheters for parenteral nutrition, hemodialysis, esophageal variceal hemorrhage, sepsis, and other clinical problems that required central venous access. These may have been complicated by thrombosis, stenosis, and infection making reaccessing these veins difficult or impossible [14]. Meticulous hygiene practice and aseptic technique are of utmost importance to minimize exposure to infectious organisms and bacteremia when attempting any invasive procedures in this population [4,8,16].…”

“…There are no prospective studies comparing anesthesia techniques, but most anesthetics have been used with success including general (inhalational, balanced, and total intravenous), neuraxial, regional, and monitored anesthesia. A successful anesthetic plan requires a clear understanding of the medical and pharmacologic problems that accompany this population, the function and physiology of the allograft, functionality and general health of the patient, the underlying surgical condition, and proposed surgical procedure [4,14].…”

Intestinal transplantation: The anesthesia perspective

“…Common indications are diagnostic procedures or standard protocol biopsies for the surveillance of rejection, bronchoscopy (opportunistic infections of the lung) and endoscopy, postoperative hemorrhage, thrombosis of the graft, colonic perforation, anastomotic leaks, bowel obstructions etc [75].…”