Anesthetic management of the first pediatric bilateral hand transplant

Gurnaney, Harshad; Fiadjoe, John E.; Levin, L. Scott; Chang, Benjamin; Delvalle, Heather; Gálvez, Jorge A.; Rehman, Mohamed A.

doi:10.1007/s12630-016-0625-y

Cited by 19 publications

(4 citation statements)

References 17 publications

(20 reference statements)

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“…Cotransplants with hand transplants included face (3 patients) and legs (2 patients) 25–27,88,108,109 . One patient was a kidney transplant recipient before receiving a bilateral hand transplant 24,25 .…”

Section: Resultsmentioning

confidence: 99%

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Two Decades of Hand Transplantation

et al. 2022

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Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of "hand" or "upper extremity" or "arm" and "transplant" or "allograft," with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.

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Section: Resultsmentioning

confidence: 99%

“…Cotransplants with hand transplants included face (3 patients) and legs (2 patients). [25][26][27]88,108,109 One patient was a kidney transplant recipient before receiving a bilateral hand transplant. 24,25 Two bilateral hand transplant recipients experienced deteriorating kidney function and eventually underwent a kidney transplant.…”

Section: Cotransplantsmentioning

confidence: 99%

Two Decades of Hand Transplantation

et al. 2022

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“…However, general anesthesia combined with adequate analgesia is preferred in limb transplantation surgery because of the long duration of the operation and the need to maintain hemodynamic stability and patient immobility. Balanced anesthesia using volatile anesthetics is preferred over total intravenous anesthesia with propofol in VCA [ 6 7 ]. Sevoflurane, which was used in this case, is known to attenuate IRI by preserving post-occlusive blood flow in the human forearm [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of the first forearm transplantation in Korea

Kwon

Jung

Kim

et al. 2018

Korean J Anesthesiol

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Vascularized composite allotransplantation for the forearm is a complex surgical procedure, requiring multidisciplinary collaboration. It is important to provide optimal blood flow to the grafts, effective immunosuppression, and early rehabilitation for graft survival and good functional outcomes. As ischemia-reperfusion injury and substantial but unquantifiable blood loss are inevitable in this type of surgery, anesthetic management should focus on providing adequate hemodynamic management with proper monitoring, and anesthetic and analgesic strategies to prevent vasoconstriction in the graft. In this paper, we describe the anesthetic management of the first forearm transplantation performed in Korea.

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“…Регионарную анестезию широко применяют в педиатрической практике в силу ее безопасности и эффективности [14,28,31,33].…”

Section: ос ложнения рег ионарной анес тезииunclassified

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

Manokhina

Александровна²

2017

Pediatr (SPb)

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The article presents an analysis of the publications devoted to the problems of anesthesia to surgical procedures at the malformations of the upper extremity in children. The article reviews the questions of epidemiology, classification of upper extremity malformation, safety of anesthesia and the role of regional blockades in the structure of intraoperative and postoperative analgesia to surgical procedures at the malformations of the upper extremity in children. Children are more likely than adults to experience stress in the operating room and early postoperative period. Children are almost impossible to prepare psychologically for the upcoming anesthesia, surgical intervention, a sense of pain after it. Surgical correction of malformations of the upper limbs in children is characterized by multistage and high traumatism, which requires the search for adequate methods of anesthesia, capable of ensuring not only the absence of pain, but also the negative impact on the nervous system of little patients. The key to the application of regional anesthesia in young children is the need for sedation or general anesthesia. The use of ultrasound navigation and electrostimulation of peripheral nerves significantly increases the level of safety and success of their realization. At present, the questions about the duration of postoperative analgesia with the use of peripheral nerve blocks and the need for additional anesthesia in the early postoperative period have been little studied. The influence of the applied anesthesia technique on the state of young children in the postoperative period are requires further investigation.

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Anesthetic management of the first pediatric bilateral hand transplant

Cited by 19 publications

References 17 publications

Two Decades of Hand Transplantation

Two Decades of Hand Transplantation

Anesthetic management of the first forearm transplantation in Korea

The regional anesthesia for surgical correction of the malformation of upper extremities in pediatric

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