Pharmacological management of patients undergoing total pancreatectomy with auto-islet transplantation

Szempruch, Kristen R.; Walter, Krysta; Ebert, Natassha; Bridgens, Kathryn; Desai, Chirag S.

doi:10.1016/j.pan.2022.04.009

Cited by 3 publications

(2 citation statements)

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“…The starting dose for ketamine is variable, ranging from 0.05 to 0.5 mg/kg/hour, and is initiated by anesthesia in the operating room. The multimodal regimen additionally includes acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and gabapentinoids [ 22 ]. Only one patient in our cohort may have suffered from withdrawal symptoms during the ICU stay, highlighting the importance of involving the pain team (either chronic or acute) early in the course as patients will initially have higher pain needs than their home regimens and will also need weaning of their narcotics.…”

Section: Discussionmentioning

confidence: 99%

“…We begin pancrelipase once the patient is eating, generally 72,000 units with meals and 24,000–48,000 units with snacks. Of note, given the peak in enzymatic activity at 30 min and the likelihood of tubes less than 14 French clogging, oral enzymatic replacement is not usually recommended with enteral feeding [ 22 ]. Fortunately, we did not have many patients who required delayed NGT removal or tube feeding.…”

Section: Discussionmentioning

confidence: 99%

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Perioperative Management of Patients Undergoing Total Pancreatectomy with/without Islet Cell Autotransplantation: A Single Center Experience

Reid

Madduri

Agala

et al. 2023

JCM

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Total pancreatectomy (TP) and islet cell autotransplantation (IAT) are complex operations that require intensive postoperative monitoring with standardized protocols. There are few studies detailing immediate perioperative management. The purpose of this study was to describe the perioperative management of post-pancreatectomy patients in the first week following surgery to guide clinicians in addressing salient points from different organ systems. This is a retrospective cohort review of prospectively collected data from September 2017 to September 2022 at a single institution, including patients 16 years and older who underwent TP or TPIAT for chronic pancreatitis. Patients were maintained on a heparin drip (TPIAT), insulin drip, and ketamine infusion. Primary outcomes were complications in the first 5 days following surgery and ICU length of stay (LOS). Secondary outcomes included overall LOS and mortality. Of 31 patients, 26 underwent TPIAT, and 5 underwent TP. Median ICU LOS was five days (IQR 4–6). The most common immediate postoperative complications were reintubation [n = 5 (16%)] and bleeding [n = 2 (6%)]. Median insulin drip use was 70 h (IQR 20–124). There was no mortality. Patients were extubated quickly and progressed well on the protocol. Immediate postoperative complications were generally minor and without long-term effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%