Face Transplantation: Medical Considerations
AbstractFace transplantation has been performed in 37 patients worldwide. To provide excellent outcomes, it is important to understand the medical considerations that are present in every aspect of this procedure. Pre-operative medical considerations are largely related to patient selection, intra-operative considerations are related to anesthesia, and post-operative considerations include complications and treatment of adverse effects of immunosuppression. This paper will discuss each area in more detail.
Authors: Luan Z, Liu B, Jiang H, Gao F, Yang B Abstract One case of epidermal granuloma of the right thumb was diagnosed by color Doppler ultrasonography and pathologic examination. Epidermal granuloma resection and reverse island skin flap transplantation were performed to determine the therapeutic effect of a reverse first dorsal metacarpal artery flap repair of an epidermal granuloma of the right thumb. After effective intravenous combined general anesthesia, the skin in the surgical field was disinfected and sterile drapes were placed. An oblique incision was made over the underlying epidermis granuloma. The ri...
Orthotopic heart transplantation performed with the bicaval technique is common in contemporary cardiac surgery and has essentially supplanted the biatrial approach. The bicaval approach is preferred because it avoids complications associated with the traditional biatrial technique, such as atrial conduction abnormalities, donor-recipient right atrial systolic dyssynchrony, and tricuspid and mitral regurgitation.1 The bicaval technique, however, can cause caval stenosis at the cannulation and anastomotic sites of the superior and inferior vena cava.
Conclusions: This study identified risk factors associated with common perioperative complications of liver transplantation. These factors may assist practitioners in risk stratification and may form the basis for further investigations of potential interventions to mitigate these risks. PMID: 31378055 [PubMed - as supplied by publisher]
CARDIOGENIC SHOCK is a state of inadequate end-organ perfusion resulting from myriad causes, including ischemia, myocarditis, acute and chronic heart failure, postcardiotomy, and post-transplantation. It is the leading cause of death among patients experiencing acute myocardial infarction, with a mortality of 40% to 50%.1 Treatment generally includes revascularization for ischemia and supportive care with inotropes, vasopressors, and fluids as needed. Refractory cardiogenic shock is defined as ongoing hypoperfusion despite the administration of multiple vasoactive medications and treatment of the underlying cause.
CONCLUSION Despite the simultaneous administration of propofol infusion in both donors and recipients, no improvement in laboratory or surgical outcome was observed after LDLT compared with patients who received desflurane anaesthesia alone. TRIAL REGISTRATION NCT02504138 at clinicaltrials.gov.
The University of Minnesota Medical Center and Masonic Children ’s Hospital EB Center offers comprehensive multidisciplinary care to children with Epidermolysis Bullosa (EB). This is the only center in the United States to offer Bone Marrow Transplantation (BMT) as a treatment for EB. To determine candidacy, these patients come to the Operating Room to have th eir dressings fully removed, labs drawn, photographs taken and skin biopsies collected under general anesthesia. The child is transported to PACU and remains under sedation while dressings are reapplied, often a 2-3 hour process.
CONCLUSIONS: Although the complication rate for patients with Krabbe disease and metachromatic leukodystrophy is higher than the general population, most complications were mild and self-limiting. These results suggest that, in experienced hands, general anesthesia is well tolerated in most children. Findings show that the Neurodevelopment in Rare Disorders classification system is a better indicator for assessing complication risk in patients with Krabbe and metachromatic leukodystrophy than American Society of Anesthesiologists Physical Status. PMID: 31359511 [PubMed - as supplied by publisher]
This study aimed to evaluate the anesthetic management of patients undergoing surgical resection for rhino-orbito-cerebral mucormycosis (ROC).The study evaluated 12 patients that underwent surgical resection for ROC mucormycosis under general anesthesia. Demographic characteristics, hemodynamic parameters, invasive monitoring methods, surgical procedures, hospital records, and mortality rates were reviewed for each patient.The patients had a median age of 58 (range, 5-86) years. Two patients had an American Society of Anesthesiologists (ASA) score of II while the remaining 10 patients had a score of III. Eleven (91.7%) pat...
SM Abstract PURPOSE: To evaluate the feasibility of intraoperative continuous renal replacement therapy (IoCRRT) during liver transplantation (LT), in terms of recruitment, protocol adherence, and ascertainment of follow-up. METHODS: In this pilot randomized open-label controlled trial in adults receiving LT with a Model for End-Stage Liver Disease (MELD) score ≥ 25 and preoperative acute kidney injury (RIFLE - RISK or higher) and/or estimated glomerular filtration rate
CONCLUSIONS: Although anecdotal reports utilizing V-B12 for vasoplegia are available, no higher-level evidence exists. Future work is necessary to further understand the dosing, timing, adverse events, and biochemical mechanisms of V-B12 compared with other therapies such as methylene blue. PMID: 31346957 [PubMed - as supplied by publisher]