Featured Research

from universities, journals, and other organizations

Anesthesia for hand or face transplants -- initial guidelines

Date:
August 30, 2012
Source:
International Anesthesia Research Society (IARS)
Summary:
Hand and facial transplants are still rare, but experience so far has produced some suggested guidelines for anesthetic management in patients undergoing these complex "composite" transplant procedures, according to a pair of articles.

Hand and facial transplants are still rare, but experience so far has produced some suggested guidelines for anesthetic management in patients undergoing these complex "composite" transplant procedures, according to a pair of articles in the September issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

The University of Pittsburgh hand transplant group shares their guidelines for anesthesia management, emphasizing the range of important roles played by anesthesiologists throughout the perioperative period -- before, during, and after surgery. A separate paper identifies key issues in the management of facial transplant recipients, based on worldwide experience.

First Guidelines for Anesthesia during Hand Transplantation

Dr R. Scott Lang and the Pitt group present the "Pittsburgh Upper Extremity Transplant Anesthesiology Protocol" (PUETAP) -- the first guidelines for anesthetic management of upper extremity transplantation. The recommendations were derived from the authors' experience with eight hand/forearm/arm transplants in five patients, performed from 2008 to 2010.

Like face transplantation, hand transplants are classified as "vascularized composite tissue allotransplants" (CTAs). In contrast to organ transplants, CTAs "are composed of multiple tissues, including skin, muscle, tendons, vessels, nerves, lymph nodes, bone, and bone marrow," the authors explain. These are obviously complex procedures in which anesthesiologists play multiple, critical roles -- not only providing anesthesia and monitoring the patient during the prolonged surgery, but also playing active roles in patient evaluation and follow-up.

The PUETAP proposes a set of recommendations to help guide anesthetic management of patients undergoing hand transplantation. It includes detailed information on management of the patient during surgery, such as:

  • Fluid management, including monitoring catheters and likely requirements for transfused blood products
  • Intraoperative monitoring, including regular lab tests performed throughout the operation.
  • Anesthesia, including regional anesthesia strategies to block the nerves supplying the shoulder, arm, and hand (brachial plexus).

The article includes two cases illustrating how experience informed development of the PUETAP, and its subsequent effects on anesthetic management. "The success of the PUETAP required the anesthesiologists to become true perioperative physicians," Dr Lang and coauthors write. They emphasize the need to meet with the patient before surgery to explain anesthesia plans, and after surgery to evaluate immediate and long-term pain management.

Follow-up also includes monitoring for immune system function and possible rejection of the transplanted tissues. The Pitt team used cutting-edge immunomodulatory approaches, including infusion of bone marrow from the tissue donor in an attempt to induce long-term immune tolerance of the transplanted tissue. The authors plan a complete review of the "immunologic, functional, and graft survival outcomes" of their hand transplant patients.

In the second article, led by Dr Thomas Edrich of Brigham and Women's Hospital, the researchers surveyed facial transplantation centers worldwide regarding their perioperative management. Data on 13 face transplants reported a median 19 hours of surgery and anesthesia. Blood loss was "considerable," requiring large amounts of fluids and blood transfusions. The results findings emphasize the importance of preparing for and managing -- which can occur rapidly once blood flow is restored to the transplanted facial tissues.

"Though most anesthesiologists will not be responsible for CTA patients, the advanced that facilitated transplantation of upper and lower extremities and faces will affect all of organ transplantation," according to an accompanying editorial by Dr Marie Csete of University of California, San Diego. Pointing out the "surprising territorial overlap" between research in anesthesiology and immunology, she believes anesthesiologists have an important role to play "at this pivotal time in the history of transplantation."


Story Source:

The above story is based on materials provided by International Anesthesia Research Society (IARS). Note: Materials may be edited for content and length.


Journal References:

  1. 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. Anesthetic Management in Upper Extremity Transplantation. Anesthesia & Analgesia, 2012; DOI: 10.1213/ANE.0b013e31825da401
  2. Thomas Edrich, Jacek B. Cywinski, Maria J. Colomina, Ignacio Jimιnez Lσpez, Lize Xiong, Amir Sedaghati, Bohdan Pomahac, Alain Gilton. Perioperative Management of Face Transplantation. Anesthesia & Analgesia, 2012; DOI: 10.1213/ANE.0b013e3182554493

Cite This Page:

International Anesthesia Research Society (IARS). "Anesthesia for hand or face transplants -- initial guidelines." ScienceDaily. ScienceDaily, 30 August 2012. <www.sciencedaily.com/releases/2012/08/120830105249.htm>.
International Anesthesia Research Society (IARS). (2012, August 30). Anesthesia for hand or face transplants -- initial guidelines. ScienceDaily. Retrieved September 17, 2014 from www.sciencedaily.com/releases/2012/08/120830105249.htm
International Anesthesia Research Society (IARS). "Anesthesia for hand or face transplants -- initial guidelines." ScienceDaily. www.sciencedaily.com/releases/2012/08/120830105249.htm (accessed September 17, 2014).

Share This



More Health & Medicine News

Wednesday, September 17, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Obesity Rates Steady Even As Americans' Waistlines Expand

Obesity Rates Steady Even As Americans' Waistlines Expand

Newsy (Sep. 17, 2014) — Researchers are puzzled as to why obesity rates remain relatively stable as average waistlines continue to expand. Video provided by Newsy
Powered by NewsLook.com
President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) — President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com
Obama Orders Military Response to Ebola

Obama Orders Military Response to Ebola

AP (Sep. 16, 2014) — Calling the Ebola outbreak in West Africa a potential threat to global security, President Barack Obama is ordering 3,000 U.S. military personnel to the stricken region amid worries that the outbreak is spiraling out of control. (Sept. 16) Video provided by AP
Powered by NewsLook.com
UN: 20,000 Could Be Infected With Ebola by Year End

UN: 20,000 Could Be Infected With Ebola by Year End

AFP (Sep. 16, 2014) — Nearly $1.0 billion dollars is needed to fight the Ebola outbreak raging in west Africa, the United Nations say, warning that 20,000 could be infected by year end. Duration: 00:40 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
 
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:  

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:  

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile iPhone Android Web
Follow Facebook Twitter Google+
Subscribe RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins