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Fiala A, Breitkopf R, Sinner B, Mathis S, Martini J. [Anesthesia for organ transplant patients]. DIE ANAESTHESIOLOGIE 2023; 72:773-783. [PMID: 37874343 PMCID: PMC10615924 DOI: 10.1007/s00101-023-01332-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 10/25/2023]
Abstract
Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important to carefully monitor the graft function in the perioperative period with respect to the occurrence of a possible rejection reaction. On the other hand, the ongoing immunosuppression may have to be adapted to the perioperative requirements in terms of the active substance and the route of administration, the resulting increased risk of infection and possible side effects (e.g., myelosuppression, nephrotoxicity and impairment of wound healing) must be included in the perioperative treatment concept. Furthermore, possible persistent comorbidities of the underlying disease and physiological peculiarities as a result of the organ transplantation must be taken into account. Support can be obtained from the expertise of the respective transplantation center.
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Affiliation(s)
- Anna Fiala
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Robert Breitkopf
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
| | - Barbara Sinner
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Simon Mathis
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
| | - Judith Martini
- Universitätsklinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich
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2
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Yuki K. Anesthetic Management for Heart Transplantation in Adults with Congenital Heart Disease. ACTA ACUST UNITED AC 2020; 7:248-252. [PMID: 32377555 PMCID: PMC7202566 DOI: 10.31480/2330-4871/120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
As the outcome of patients with congenital heart disease (CHD) has improved, the number of adults with congenital heart disease (ACHD) outnumbered pediatric population with CHD. Heart failure is responsible for 40% of mortality among ACHD, and the number of heart transplantation for ACHD is gradually increasing. However, the early mortality rate of heart transplantation is significantly higher in ACHD than in non-ACHD. Understanding the unique characteristics of heart transplantation in ACHD is critical. In contrast to their early outcome their long-term survival is better in ACHD than in non-CHD patients, and they are likely to present to anesthesia care after heart transplantation for various reasons. Understanding specific issues in post-transplant anesthesia care is another important aspect.
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Affiliation(s)
- Koichi Yuki
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.,Department of Anaesthesia, Harvard Medical School, USA
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3
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Chua AWY, Chua MJ, Harrisberg BP, Kumar CM. Review of anaesthetic management for cataract surgery in transplant recipients. Anaesth Intensive Care 2020; 48:25-35. [DOI: 10.1177/0310057x19891737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The prevalence of transplantation is on the increase worldwide. Corneal transplantation is the most common form of human donor transplantation. Transplantation of other organs and bone marrow is established treatment for various end-organ failure and many haematological conditions, respectively. Success and survival of these patients have increased with advances in immunosuppression. Unfortunately, these patients are susceptible to cataract formation as a consequence of immunosuppressive therapy and accelerated progression of several diseases. Topical anaesthesia and regional ophthalmic blocks are ideal for cataract surgery in cooperative adults. General anaesthesia may be required in children, for extremely anxious or claustrophobic adults and for complex surgery such as simultaneous cataract and corneal transplantation. The perioperative anaesthetic management of cataract surgery in a transplant recipient is no different to a standard technique in a healthy adult, but additional challenges are posed by the underlying pathology necessitating transplantation, function of the transplanted organ, physiological and pharmacological problems of allograft denervation, side-effects of immunosuppression, risk of infection and potential for rejection. This narrative review summarises optimal anaesthetic management in transplant recipients undergoing cataract surgery.
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Affiliation(s)
- Alfred WY Chua
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | | | - Brian P Harrisberg
- Ophthalmology Department, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Chandra M Kumar
- Department of Anaesthesia, Khoo Teck Puat Hospital, Singapore
- Newcastle University, Newcastle, UK
- Newcastle University Medical School, Johor, Malaysia
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4
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Carlos RV, Torres MLA, de Boer HD. Reversão do bloqueio neuromuscular com sugamadex em cinco receptores pediátricos de transplante cardíaco. Rev Bras Anestesiol 2018; 68:416-420. [DOI: 10.1016/j.bjan.2017.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022] Open
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5
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Miller K, Hall B, Tobias JD. Sugammadex to reverse neuromuscular blockade in a child with a past history of cardiac transplantation. Ann Card Anaesth 2018; 20:376-378. [PMID: 28701612 PMCID: PMC5535588 DOI: 10.4103/aca.aca_15_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sugammadex is a novel agent for the reversal of neuromuscular blockade. The speed and efficacy of reversal with sugammadex are significantly faster than acetylcholinesterase inhibitors, such as neostigmine. Sugammadex also has a limited adverse profile when compared with acetylcholinesterase inhibitors, specifically in regard to the incidence of bradycardia. This adverse effect may be particularly relevant in the setting of a heart transplant recipient with a denervated heart. The authors present a case of an 8-year-old child, status postcardiac transplantation, who required anesthetic care for laparoscopy and lysis of intra-abdominal adhesions. Sugammadex was used to reverse neuromuscular blockade and avoid the potential adverse effects of neostigmine. The unique mechanism of action of sugammadex is discussed, previous reports of its use in this unique patient population are reviewed, and its potential benefits compared to traditional acetylcholinesterase inhibitors are presented.
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Affiliation(s)
- Karen Miller
- The Ohio State University College of Medicine, Ohio, USA
| | - Brian Hall
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Ohio, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Nassirou OMM, Jaafari A, Chlouchi A, Bensghir M, Haimeur C. [Anaesthesia for noncardiac surgery in a heart-transplanted patient: a clinical case and review of the literature]. Pan Afr Med J 2017; 24:284. [PMID: 28154639 PMCID: PMC5267784 DOI: 10.11604/pamj.2016.24.284.9884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/04/2016] [Indexed: 11/11/2022] Open
Abstract
Le nombre et la durée de survie des patients transplantés cardiaque sont en augmentation. Une partie de ces patients se présentent régulièrement pour une chirurgie générale en dehors de la transplantation cardiaque. L’anesthésie chez ces patients peut être difficile en raison des particularités physiologiques du cœur dénervé et de la gestion du traitement immunosuppresseur avec le risque de rejet et d’infection. Nous discutons la prise en charge anesthésique à travers un cas d’un patient âgé de 60 ans transplanté cardiaque devant subir une chirurgie de cure d’éventration abdominale et une revue de la littérature.
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Affiliation(s)
| | - Abdelhamid Jaafari
- Pôle Anesthésie Réanimation, Hôpital Militaire Mohammed V, Université Mohammed V Souissi, Rabat, Maroc
| | - Abdellatif Chlouchi
- Pôle Anesthésie Réanimation, Hôpital Militaire Mohammed V, Université Mohammed V Souissi, Rabat, Maroc
| | - Mustapha Bensghir
- Pôle Anesthésie Réanimation, Hôpital Militaire Mohammed V, Université Mohammed V Souissi, Rabat, Maroc
| | - Charki Haimeur
- Pôle Anesthésie Réanimation, Hôpital Militaire Mohammed V, Université Mohammed V Souissi, Rabat, Maroc
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7
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Non-cardiac Surgery After Heart Transplantation. Anesthesiology 2017. [DOI: 10.1007/978-3-319-50141-3_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The annual heart transplant rate is gradually increasing worldwide. A proportion of this patient population present for an elective or emergency surgery which may or may not be related to the transplanted heart. A MEDLINE search for heart transplant, anaesthesia, adult, paediatric and surgery was conducted to review anaesthetic management for heart transplant recipients. Anaesthesia and perioperative management are different in these cases. A thorough understanding of the physiology of denervated heart, post-transplant morbidities and pharmacology of immunosuppressants is essential for best perioperative management and improved post-operative outcome.
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Affiliation(s)
- Minati Choudhury
- Department of Cardiac Anesthesia, Cardiothoracic Sciences Centre, AIIMS, New Delhi, India
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9
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The Safety of Neuromuscular Blockade Reversal in Patients With Cardiac Transplantation. Transplantation 2016; 100:2723-2728. [DOI: 10.1097/tp.0000000000001060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Cachemaille M, Olofsson M, Livio F, Pascale P, Zingg T, Boegli Y. Recurrent Asystole After Neostigmine in a Heart Transplant Recipient With End-Stage Renal Disease. J Cardiothorac Vasc Anesth 2016; 31:653-656. [PMID: 27663634 DOI: 10.1053/j.jvca.2016.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Matthieu Cachemaille
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
| | - Magnus Olofsson
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Françoise Livio
- Division de Pharmacologie Clinique, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Patrizio Pascale
- Service de Cardiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Tobias Zingg
- Service de Chirurgie Viscérale, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Yann Boegli
- Service d'Anesthésiologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Tezcan B, Şaylan A, Bölükbaşı D, Koçulu R, Karadeniz Ü. Use of Sugammadex in a Heart Transplant Recipient: Review of the Unique Physiology of the Transplanted Heart. J Cardiothorac Vasc Anesth 2015; 30:462-5. [PMID: 26409923 DOI: 10.1053/j.jvca.2015.06.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Büşra Tezcan
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey.
| | - Alev Şaylan
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Demet Bölükbaşı
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Rabia Koçulu
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
| | - Ümit Karadeniz
- Yüksek İhtisas Education and Research Hospital, Ankara, Turkey
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12
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Farhan H, Moreno-Duarte I, McLean D, Eikermann M. Residual Paralysis: Does it Influence Outcome After Ambulatory Surgery? CURRENT ANESTHESIOLOGY REPORTS 2014; 4:290-302. [PMID: 25530723 PMCID: PMC4267566 DOI: 10.1007/s40140-014-0073-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it's use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice.
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Affiliation(s)
- Hassan Farhan
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Ingrid Moreno-Duarte
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Duncan McLean
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
| | - Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, 55, Fruit Street, Boston, MA 02115, USA
- Universitaet Duisburg-Essen, Essen, Germany
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13
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Pandya SR, Paranjape S. Laparoscopic cholecystectomy in a cardiac transplant recipient. Saudi J Anaesth 2014; 8:287-9. [PMID: 24843350 PMCID: PMC4024694 DOI: 10.4103/1658-354x.130752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
An increasing number of cardiac transplants are being carried out around the world. With increasing longevity, these patients present a unique challenge to non-transplant anesthesiologists for a variety of transplant related or incidental surgeries. The general considerations related to a cardiac transplant recipient are the physiological and pharmacological problems of allograft denervation, the side-effects of immunosuppression, the risk of infection and the potential for rejection. A thorough understanding of the physiology of a denervated heart, need for direct vasoactive agents and post-transplant morbidities is essential in anesthetic management of such a patient. Here, we describe a case of a heart transplant recipient who presented for a cholecystectomy at our center.
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Affiliation(s)
- Seema R Pandya
- Department of Anesthesia, Lilavati Hospital and Research Centre, Bandra Reclamation, Mumbai, Maharashtra, India
| | - Saloni Paranjape
- Department of Anesthesia, Lilavati Hospital and Research Centre, Bandra Reclamation, Mumbai, Maharashtra, India
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14
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Bertolizio G, Yuki K, Odegard K, Collard V, DiNardo J. Cardiac Arrest and Neuromuscular Blockade Reversal Agents in the Transplanted Heart. J Cardiothorac Vasc Anesth 2013; 27:1374-8. [DOI: 10.1053/j.jvca.2012.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Indexed: 11/11/2022]
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15
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Gómez-Ríos MÁ. Anaesthesia for non-cardiac surgery in a cardiac transplant recipient. Indian J Anaesth 2012; 56:88-9. [PMID: 22529432 PMCID: PMC3327085 DOI: 10.4103/0019-5049.93356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Manuel Á Gómez-Ríos
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Complex of A Coruña, Galicia, Spain
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16
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Rumore MM, Lee SE, Wang S, Farmer B. Metoclopramide-induced cardiac arrest. Clin Pract 2011; 1:e83. [PMID: 24765383 PMCID: PMC3981421 DOI: 10.4081/cp.2011.e83] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/12/2011] [Indexed: 12/02/2022] Open
Abstract
The authors report a case of cardiac arrest in a patient receiving intravenous (IV) metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV) injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG) revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT) associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs) related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s) underlying metoclopramide's cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and reporting of bradydysrrhythmias and cardiac arrest in patients receiving metoclopramide.
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Affiliation(s)
- Martha M Rumore
- Drug Information, New York -Presbyterian Hospital; ; Pharmacy & Health Outcomes, Touro College of Pharmacy, New York
| | - Spencer Evan Lee
- St. John's University, College of Pharmacy and Allied Health Professions, Jamaica
| | - Steven Wang
- St. John's University, College of Pharmacy and Allied Health Professions, Jamaica
| | - Brenna Farmer
- Division of Emergency Medicine, Weill-Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA
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17
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Abstract
Constipation is a common complication in critically ill children and it is occasionally resistant to the drugs typically used in treatment. Neostigmine has been used in some cases of refractory constipation in critically ill adults. There is no reference to its use in critically ill children. We describe 3 cases of refractory constipation in critically ill children treated with intravenous neostigmine by continuous infusion. Two patients responded well. There were no adverse effects. We conclude that continuous intravenous neostigmine can be effective in critically ill children with refractory constipation. Further studies are necessary to determine the dose and safety of the treatment.
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Schure AY, Kussman BD. Pediatric heart transplantation: demographics, outcomes, and anesthetic implications. Paediatr Anaesth 2011; 21:594-603. [PMID: 20880157 DOI: 10.1111/j.1460-9592.2010.03418.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The evolving demographics, outcomes, and anesthetic management of pediatric heart transplant recipients are reviewed. As survival continues to improve, an increasing number of these patients will present to our operating rooms and sedation suites. It is therefore important that all anesthesiologists, not only those specialized in cardiac anesthesia, have a basic understanding of the physiologic changes in the transplanted heart and the anesthetic implications thereof.
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Affiliation(s)
- Annette Y Schure
- Department of Anesthesiology, Perioperative and Pain Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA.
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d'Hollander AA, Bourgain JL. [Residual curarization and pharyngeal muscles: remain vigilant!]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2009; 28:868-877. [PMID: 19854607 DOI: 10.1016/j.annfar.2009.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 07/08/2009] [Indexed: 05/28/2023]
Abstract
The different concepts treating of "residual curarization" were presented according to two directions: the analysis of their contents--epidemiologic, clinical, instrumental--and the description of the pharyngeal striated muscles functions in these contexts. It appears that certain, too marked, "residual curarization" levels remain a well-evidenced factor increasing some morbidities in numerous clinical situations. All the methods of instrumental monitoring of the level of curarization--mecanography, electromyography, accelerometry--appeared useful to document the levels of "residual curarization" before patient's extubation or awakening. Today, for our speciality, it became particularly clear that: neither the selected muscle-- adductor pollicis--, neither the test currently privileged--train-of-four 2Hz--, nor the thresholds currently selected--0.90 or 1.00--did not constitute the unavoidable proof of a "residual curarization" complete absence. For the healthy volunteer receiving a curare, a train of four of the adductor pollicis greater than 0.90 can exist in presence of spirometric alterations evidencing the lack of adequate pharyngeal dilatation. In daily routine, the pharyngeal control is already disturbed by numerous molecules including: benzodiazepines, halogenated vapours, propofol, i.e. even under non-hypnotic concentrations. Faced to such evidences, our medical speciality will, undoubtedly, have to acquire new knowledge to develop muscle relaxant management control processes eliminating the surmorbidities related to "residual curarization". These tests must be validated also to exclude morbidity-prone dysfunctions of the pharyngeal striated muscles. Considering this new paradigm would be a major safety evolution for our speciality.
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20
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Kopman AF, Eikermann M. Antagonism of non-depolarising neuromuscular block: current practice. Anaesthesia 2009; 64 Suppl 1:22-30. [DOI: 10.1111/j.1365-2044.2008.05867.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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McLeod ADM, Barker EV, Carapiet DA. Successful use of remifentanil for major head and neck surgery in a heart-lung transplant recipient. Br J Anaesth 2004; 93:473-4. [PMID: 15304419 DOI: 10.1093/bja/aeh605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Over the past 30 years, heart transplantation has evolved into a definitive therapy for patients with end-stage cardiomyopathy. However, perioperative management of patients undergoing heart transplantation remains a challenge for anesthesiologists. The presence of biventricular failure, arrhythmias and associated multisystem organ dysfunction may contribute to significant intraoperative hemodynamic instability prior to the initiation of cardiopulmonary bypass (CPB). Even after an uneventful transplantation, weaning from CPB may be difficult. Acute right ventricular failure can develop in the recipient secondary to pre-existing pulmonary hypertension. Treatment options frequently focus on therapeutic interventions directed towards decreasing pulmonary vascular resistance and improving right ventricular contractility. Intraoperative use of transesophageal echocardiography (TEE) enables the anesthesiologist to diagnose acute right ventricular failure early on and guide therapy. Concurrent pathology including kinking of the pulmonary artery anastomosis or valvular insufficiency in the transplanted heart can also be recognized and addressed. The number of patients undergoing cardiac transplantation is continually increasing. In addition, the use of more effective immunosuppressive agents has curtailed transplant rejection and permitted longer survival. Consequently, heart transplant recipients are more frequently presenting for non-cardiac surgical procedures. Thus, an understanding of physiological and pharmacological implications associated with heart transplantation is crucial for managing these patients in the perioperative period.
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Affiliation(s)
- H K Eltzschig
- Klinik für Anaesthesiologie und Intensivmedizin, Eberhard-Karls-Universität Tübingen.
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24
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Booij LH, de Boer HD, van Egmond J. Reversal agents for nondepolarizing neuromuscular blockade: Reasons for and development of a new concept. ACTA ACUST UNITED AC 2002. [DOI: 10.1053/sane.2002.34114] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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