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العنوان
Anesthetic Considerations for Pancreatic Transplantation /
المؤلف
Awad, Aya El Sayed Ahmed.
هيئة الاعداد
باحث / Aya El Sayed Ahmed Awad
مشرف / Galal Adel A.Raheem Al-kady
مشرف / Sahar Mohamed Talaat Taha
مناقش / Mohamed Osman Awad Taeimah
تاريخ النشر
2014.
عدد الصفحات
109p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
التخدير و علاج الألم
تاريخ الإجازة
1/1/2014
مكان الإجازة
جامعة عين شمس - كلية الطب - Anesthesia, Intensive Care and Pain Management
الفهرس
Only 14 pages are availabe for public view

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from 109

Abstract

Pancreas transplant is a surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to stop taking insulin injections.
There are three main categories of pancreas transplantation simultaneous pancreas-kidney, pancreas after kidney , and pancreas alone transplant.
The most common operation by far is the SPK. The American Diabetes Association (ADA) criteria for transplantation are as follows ,patients with end stage renal disease who have had or plan to have a kidney transplant are candidates for pancreas transplantation and patients without substantial renal disease who are candidates for pancreas transplantation alone if they have a history of frequent, acute, severe metabolic complications (hypoglycemia, marked hyperglycemia, ketoacidosis.
Patients must have documented Type 1diabetes as there is no evidence to support transplantation in those with Type 2 diabetes and insulin resistance
There are mandatory tests done before the procedure include tissue and blood typing to help and make sure that the patient body will not reject the donated kidney and pancreas. Blood tests or skin tests to check for infections. Heart tests such as an ECG, echocardiogram or cardiac catheterization. Tests to look for early cancer.
There are many factors that affect the donor some of them are not amenable to change like age and BMI and serum lipase. During normal aging, the number of insulin-producing cells (beta cells) within the pancreas declines ,donor with a larger BMI may have more beta-cell mass but less insulin reserve due to insulin resistance also elevated serum amylase level may exclude the pancreas from donation.
Factors Amenable to Change During Donor care are Blood Glucose Level, Donor hyperglycemia appears to be associated with some adverse effect according to several studies. Length of ICU Admission, Cold ischemia time (CIT) and warm ischemia time have the same importance to whole pancreas transplantation as they would have for transplantation of any other solid organ. Hypotension, Use of Vasoactive Drugs, or Cardiac Arrest
During preoperative evaluation period the transplant anesthesiologist should evaluate all patients prior to their approval for pancreas transplantation. The assessment of each candidate should always include a thorough evaluation for end organ disease associated with diabetes. Additionally, an evaluation of other preexisting comorbidities, a comprehensive airway exam, and evaluation of vascular access sites should also be performed during this initial exam
Pancreas transplantation is typically performed under general anesthesia following graft recirculation, pancreatic beta cells begin secreting insulin within 5 minutes, so careful attention to glucose levels is paramount . Blood glucose levels should be assessed every 15 minutes for the first hour, then every 30 minutes thereafter for the duration of the surgical case. The goal of tight glucose control is to prevent hyperglycemia induced islet cell dysfunction and to rest the beta cells until reperfusion abnormalities have normalized
Typically most patients’ pain is well managed using patient controlled analgesia with either morphine or hydromorphone in patients with renal failure
Epidural anesthesia is typically avoided as many centers administer anticoagulation postoperatively to minimize the risk of vascular thrombosis.