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.
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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
Hevesi ZG, Lopukhin SY, Angelini G, et al. Supportive care after brain death for the donor candidate. Int Anesthesiol Clin. 2006;44:21-34.
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.
Shah VR. Aggressive management of multiorgan donor. Transplant Proc. 2008;40:1087-1090.
DuBose J, Salim A. Aggressive organ donor management protocol. J Intensive Care Med. 2008;23:367-375.
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.
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.
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.
Gann M Jr, Sardi A. Improved results using ultrasound guidance for central venous access. Am Surg. 2003;69:1104-1107.
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.
Adams J, Charlton P. Anaesthesia for microvascular free tissue transfer. Br J Anaesth CEPD Rev. 2003;3:33-37.
Kusza K, Siemionow M, Nalbantoglu U, et al. Microcirculatory response to halothane and isoflurane anesthesia. Ann Plast Surg. 1999;43:57-66.
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.
Hagau N, Longrois D. Anesthesia for free vascularized tissue transfer. Microsurgery. 2009;29:161-167.
Liu X, Peter FW, Barker JH, et al. Leukocyte-endothelium interaction in arterioles after ischemia and reperfusion. J Surg Res. 1999;87:77-84.
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.
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.
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.
Marx G, Schuerholz T. Fluid-induced coagulopathy: does the type of fluid make a difference? Crit Care. 2010;14:118.
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.
Triulzi DJ. The art of plasma transfusion therapy. Transfusion. 2006;46(8):1268-1270.
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.
Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-659.
Cohen LB, DeLegge MH, Aisenberg J, et al. AGA Institute review of endoscopic sedation. Gastroenterology. 2007;133:675-701.
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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
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DOI: https://doi.org/10.1007/978-0-85729-253-7_9
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