During the course of surgery for a 2-year-old undergoing renal transplant
surgery with a living-related donor organ, the surgeon alerts you that she is
preparing for reperfusion. As the anesthesiologist, you prepare for the potential
sequelae by:
a) Ensuring that room temperature fluids are available, and turning the
circulating air body warmer to low.
b) Checking an arterial blood gas and preparing dopamine, calcium and atropine
for administration.
c) Administering furosemide and mannitol prior to unclamping of the IVC.
d) Increase the CVP to 26 mmHg in anticipation of redistribution of blood flow.
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Answer
Answer b. Reperfusion of an adult donor graft may precipitate impressive blood
sequestration and profound hypotension, as well as the release of metabolic
byproducts from preservation and/or clamping of the lower extremities. In
addition, the graft is traditionally kept on ice and reperfusion can cause
hypothermia. A CVP between 18 and 20 mmHg is usually recommended before
reperfusion, and diuretics should only be administered after renal blood flow is
re-established.
Notes
- This question originally printed in the Pediatric Anesthesiology Review Topics kindle book series, and appears courtesy of Naerthwyn Press, LLC.
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