Skip to main content

Anesthetic Care for Face Transplantation

  • Chapter
  • First Online:
The Know-How of Face Transplantation

Abstract

This chapter will address the current state of clinical experience and scientific knowledge in the perioperative management of the face transplant recipient and donor. Areas of controversy will be discussed, and practical approaches to the preoperative, intraoperative and postoperative care of the face transplant recipient will be presented. Several key points should be emphasized: airway management can be a special challenge and often involves tracheostomies in both the donor and the recipient; fluid management is especially important in ensuring good graft perfusion in both the donor and the recipient; and there may be periods where muscle relaxation should be avoided to facilitate nerve identification using electrical stimulation. A critically important consideration is that the anesthesia and surgical teams jointly discuss their clinical plans.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ICU:

intensive care unit

PICC:

peripherally inserted central catheter

TA-GVHD:

transfusion-associated graft-versus-host disease

TEG:

thromboelastograph®

TIVA:

total intravenous anesthesia

TRALI:

transfusion-related associated lung injury

References

  1. Hevesi ZG, Lopukhin SY, Angelini G, et al. Supportive care after brain death for the donor candidate. Int Anesthesiol Clin. 2006;44:21-34.

    Article  Google Scholar 

  2. Venkateswaran RV, Patchell VB, Wilson IC, et al. Early donor management increases the retrieval rate of lungs for transplantation. Ann Thorac Surg. 2008;85:278-286.

    Article  Google Scholar 

  3. Shah VR. Aggressive management of multiorgan donor. Transplant Proc. 2008;40:1087-1090.

    Article  CAS  Google Scholar 

  4. DuBose J, Salim A. Aggressive organ donor management protocol. J Intensive Care Med. 2008;23:367-375.

    Article  Google Scholar 

  5. American Society of Anesthesiologists. Standards for basic anesthetic monitoring. American Society of Anesthesiologists. 2005. http://www.asahq.org/publicationsAndServices/standards/02_OnlinePDF.pdf. Accessed May 14, 2010.

  6. Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009;37:2642-2647.

    Article  Google Scholar 

  7. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81:1159-1171.

    Article  Google Scholar 

  8. Gann M Jr, Sardi A. Improved results using ultrasound guidance for central venous access. Am Surg. 2003;69:1104-1107.

    PubMed  Google Scholar 

  9. Renard D, Dutray A, Remy A, et al. Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia. Neurol Sci. 2009;30:75-76.

    Article  Google Scholar 

  10. Adams J, Charlton P. Anaesthesia for microvascular free tissue transfer. Br J Anaesth CEPD Rev. 2003;3:33-37.

    Google Scholar 

  11. Kusza K, Siemionow M, Nalbantoglu U, et al. Microcirculatory response to halothane and isoflurane anesthesia. Ann Plast Surg. 1999;43:57-66.

    Article  CAS  Google Scholar 

  12. Sigurdsson GH, Banic A, Wheatley AM, et al. Effects of halothane and isoflurane anaesthesia on microcirculatory blood flow in musculocutaneous flaps. Br J Anaesth. 1994;73:826-832.

    Article  CAS  Google Scholar 

  13. Hagau N, Longrois D. Anesthesia for free vascularized tissue transfer. Microsurgery. 2009;29:161-167.

    Article  Google Scholar 

  14. Liu X, Peter FW, Barker JH, et al. Leukocyte-endothelium interaction in arterioles after ischemia and reperfusion. J Surg Res. 1999;87:77-84.

    Article  CAS  Google Scholar 

  15. Kusza K, Blaszyk M, Siemionow M, et al. Alteration in peripheral microcirculatory haemodynamics of muscle flaps during propofol infusion anaesthesia. Anaesthesiol Intens Ther. 2002;34:187-193.

    Google Scholar 

  16. Holzmann A, Schmidt H, Gebhardt MM, et al. Propofol-induced alterations in the microcirculation of hamster striated muscle. Br J Anaesth. 1995;75:452-456.

    Article  CAS  Google Scholar 

  17. Brookes ZL, Brown NJ, Reilly CS. The dose-dependent effects of fentanyl on rat skeletal muscle microcirculation in vivo. Anesth Analg. 2003;96:456-462.

    CAS  PubMed  Google Scholar 

  18. Marx G, Schuerholz T. Fluid-induced coagulopathy: does the type of fluid make a difference? Crit Care. 2010;14:118.

    Article  Google Scholar 

  19. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006;105:198-208.

    Article  Google Scholar 

  20. Triulzi DJ. The art of plasma transfusion therapy. Transfusion. 2006;46(8):1268-1270.

    Article  Google Scholar 

  21. American Society of Anesthesiologists Committee on Transfusion Medicine. Questions and Answers About Blood Management, 4th Edn. American Society of Anesthesiologists. 2008. http://www.asahq.org/publicationsAndServices/transfusion_OnlinePDF.pdf. Accessed May 14, 2010.

  22. Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-659.

    Article  CAS  Google Scholar 

  23. Cohen LB, DeLegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675-701.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jacek B. Cywinski .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer London

About this chapter

Cite this chapter

Cywinski, J.B., Doyle, D.J., Kusza, K. (2011). Anesthetic Care for Face Transplantation. In: Siemionow, M. (eds) The Know-How of Face Transplantation. Springer, London. https://doi.org/10.1007/978-0-85729-253-7_9

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-253-7_9

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-252-0

  • Online ISBN: 978-0-85729-253-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics