Fluid Management of Patients Undergoing Intestinal and Multivisceral Transplantation

Anesthetic management for intestinal transplantation: A decade of experience

“…Siniscalchi's group drew from a modest sample of less than 30 patients and described their anesthetic management in a cohort similar to our group's. They included the placement of a single arterial line, but with two 8‐Fr or greater central venous catheters and a PAC.…”

“…These patients often have had numerous prior surgeries making surgical dissection challenging and prolonged with significant insensible fluid losses . The Siniscalchi group reported surgical times of 640 vs 564 min for our group, shorter cold ischemia times of 376 vs 434 min, and longer warm ischemia times of 42 vs 31 min . Despite shorter operative times, overall we administered more crystalloid: 9000 vs 8484 mL; but less colloid: 1000 vs 1496 mL.…”

Intestinal transplantation: The anesthesia perspective

“…Volume monitoring is essential as large quantities of fluid maybe required during and after small bowel transplantation [52]. There can be large intraoperative fluid shifts.…”

“…Massive blood loss, dehydration, vascular clamping, long ischemia times, intraoperative visceral exposure, intestinal denervation, ischemic damage, and lymphatic interruption are some of the causes of these large fluid shifts [53,54]. There maybe massive extravasation of fluids into the third space resulting in intravascular depletion [52]. It was found that the amount of crystalloid administered in a multivisceral transplantation ranged from 5 L to 17 L whereas it ranged from 5 to 15 L in isolated small bowel transplantation.…”

“…It was found that the amount of crystalloid administered in a multivisceral transplantation ranged from 5 L to 17 L whereas it ranged from 5 to 15 L in isolated small bowel transplantation. The amount of colloid administered ranged from 0 to 4.5 L and from 0 to 5.5 L in multivisceral and isolated small bowel transplantation respectively [52].…”