TYK300
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.
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.