Anesthetic management in upper extremity transplantation: The pittsburgh experience

R. Scott Lang, Vijay S. Gorantla, Stephen Esper, Mario Montoya, Joseph E. Losee, Ibtesam A. Hilmi, Tetsuro Sakai, W. P. Andrew Lee, Jay S. Raval, Joseph E. Kiss, Jaimie T. Shores, Gerald Brandacher, Raymond M. Planinsic

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

Background: Hand/forearm/arm transplants are vascularized composite allografts, which, unlike solid organs, are composed of multiple tissues including skin, muscle, tendons, vessels, nerves, lymph nodes, bone, and bone marrow. Over the past decade, 26 upper extremity transplantations were performed in the United States. The University of Pittsburgh Medical Center has the largest single center experience with 8 hand/forearm transplantations performed in 5 recipients between January 2008 and September 2010. Anesthetic management in the emerging field of upper extremity transplants must address protocol and procedure-specific considerations related to the role of regional blocks, effects of immunosuppressive drugs during transplant surgery, fluid and hemodynamic management in the microsurgical setting, and rigorous intraoperative monitoring during these often protracted procedures. Methods: For the first time, we outline salient aspects of upper extremity transplant anesthesia based on our experience with 5 patients. We highlight the importance of minimizing intraoperative vasopressors and improving fluid management and blood product use. Results: Our approach reduced the incidence of perioperative bleeding requiring re-exploration or hemostasis and shortened in-hospital and intensive care unit stay. Functional, immunologic and graft survival outcomes have been highly encouraging in all patients. Conclusions: Further experience is required for validation or standardization of specific anesthetic protocols. Meanwhile, our recommendations are intended as pertinent guidelines for centers performing these novel procedures.

Original languageEnglish (US)
Pages (from-to)678-688
Number of pages11
JournalAnesthesia and analgesia
Volume115
Issue number3
DOIs
StatePublished - Sep 1 2012
Externally publishedYes

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Scott Lang, R., Gorantla, V. S., Esper, S., Montoya, M., Losee, J. E., Hilmi, I. A., Sakai, T., Andrew Lee, W. P., Raval, J. S., Kiss, J. E., Shores, J. T., Brandacher, G., & Planinsic, R. M. (2012). Anesthetic management in upper extremity transplantation: The pittsburgh experience. Anesthesia and analgesia, 115(3), 678-688. https://doi.org/10.1213/ANE.0b013e31825da401