Anesthetic Management of Brain-dead Adult and Pediatric Organ Donors: The Harborview Medical Center Experience.
Journal
Journal of neurosurgical anesthesiology
ISSN: 1537-1921
Titre abrégé: J Neurosurg Anesthesiol
Pays: United States
ID NLM: 8910749
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
received:
26
10
2019
accepted:
10
02
2020
pubmed:
10
3
2020
medline:
15
12
2021
entrez:
10
3
2020
Statut:
ppublish
Résumé
The exposure of anesthesiologists to organ recovery procedures and the anesthetic technique used during organ recovery has not been systematically studied in the United States. A retrospective cohort study was conducted on all adult and pediatric patients who were declared brain dead between January 1, 2008, and June 30, 2019, and who progressed to organ donation at Harborview Medical Center. We describe the frequency of directing anesthetic care by attending anesthesiologists, anesthetic technique, and donor management targets during organ recovery. In a cohort of 327 patients (286 adults and 41 children), the most common cause of brain death was traumatic brain injury (51.1%). Kidneys (94.4%) and liver (87.4%) were the most common organs recovered. On average, each year, an attending anesthesiologist cared for 1 (range: 1 to 7) brain-dead donor during organ retrieval. The average anesthetic time was 127±53.5 (mean±SD) minutes. Overall, 90% of patients received a neuromuscular blocker, 63.3% an inhaled anesthetic, and 33.9% an opioid. Donor management targets were achieved as follows: mean arterial pressure ≥70 mm Hg (93%), normothermia (96%), normoglycemia (84%), urine output >1 to 3 mL/kg/h (61%), and lung-protective ventilation (58%). During organ recovery from brain-dead organ donors, anesthesiologists commonly administer neuromuscular blockers, inhaled anesthetics, and opioids, and strive to achieve donor management targets. While infrequently being exposed to these cases, it is expected that all anesthesiologists be cognizant of the physiological perturbations in brain-dead donors and achieve physiological targets to preserve end-organ function. These findings warrant further examination in a larger multi-institutional cohort.
Identifiants
pubmed: 32149890
pii: 00008506-202201000-00014
doi: 10.1097/ANA.0000000000000683
doi:
Substances chimiques
Anesthetics
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e34-e39Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
A.V.L.: received research support from Aqueduct Critical Care and salary support from LifeCenter Northwest. M.J.S.: received salary support from LifeCenter Northwest and is a consultant for Teleflex Medical Inc. B.G.N. holds equity in Perimatics LLC and is its Chief Solution Architect. The remaining authors have no funding or conflicts of interest to disclose.
Références
Health Resources and Services Administration, US Department of Health & Human Services, Organ Procurement & Transplantation Network. National Data; 2019. Available at: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/# . Accessed September 15, 2019.
Anderson TA, Bekker P, Vagefi PA. Anesthetic considerations in organ procurement surgery: a narrative review. Can J Anaesth. 2015;62:529–539.
Gelb AW, Robertson KM. Anaesthetic management of the brain dead for organ donation. Can J Anaesth. 1990;37:806–812.
Rosendale JD, Kauffman HM, McBride MA, et al. Aggressive pharmacologic donor management results in more transplanted organs. Transplantation. 2003;75:482–487.
Champigneulle B, Neuschwander A, Bronchard R, et al. Intraoperative management of brain-dead organ donors by anesthesiologists during an organ procurement procedure: results from a French survey. BMC Anesthesiol. 2019;19:108.
Souter MJ, Eidbo E, Findlay JY, et al. Organ donor management: part 1. Toward a consensus to guide anesthesia services during donation after brain death. Semin Cardiothorac Vasc Anesth. 2018;22:211–222.
Boutin C, Vachiery-Lahaye F, Alonso S, et al. Anaesthetic management of brain-dead for organ donation: impact on delayed graft function after kidney transplantation. Ann Fr Anesth Reanim. 2012;31:427–436.
Wetzel RC, Setzer N, Stiff JL, et al. Hemodynamic responses in brain dead organ donor patients. Anesth Analg. 1985;64:125–128.
Dal Molin SZ, Kruel CR, de Fraga RS, et al. Differential protective effects of anaesthesia with sevoflurane or isoflurane: an animal experimental model simulating liver transplantation. Eur J Anaesthesiol. 2014;31:695–700.
Jeong JS, Kim D, Kim KY, et al. Ischemic preconditioning produces comparable protection against hepatic ischemia/reperfusion injury under isoflurane and sevoflurane anesthesia in rats. Transplant Proc. 2017;49:2188–2193.
Minou AF, Dzyadzko AM, Shcherba AE, et al. The influence of pharmacological preconditioning with sevoflurane on incidence of early allograft dysfunction in liver transplant recipients. Anesthesiol Res Pract. 2012;2012:930487.
Beck-Schimmer B, Breitenstein S, Urech S, et al. A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic. Ann Surg. 2008;248:909–918.
Perez-Protto S, Nazemian R, Matta M, et al. The effect of inhalational anaesthesia during deceased donor organ procurement on post-transplantation graft survival. Anaesth Intensive Care. 2018;46:178–184.
Elkins LJ. Inhalational anesthesia for organ procurement: potential indications for administering inhalational anesthesia in the brain-dead organ donor. AANA J. 2010;78:293–299.
Young PJ, Matta BF. Anaesthesia for organ donation in the brainstem dead—why bother? Anaesthesia. 2000;55:105–106.
Saposnik G, Basile VS, Young GB. Movements in brain death: a systematic review. Can J Neurol Sci. 2009;36:154–160.
Fitzgerald RD, Hieber C, Schweitzer E, et al. Intraoperative catecholamine release in brain-dead organ donors is not suppressed by administration of fentanyl. Eur J Anaesthesiol. 2003;20:952–956.
Patel MS, Niemann CU, Sally MB, et al. The impact of hydroxyethyl starch use in deceased organ donors on the development of delayed graft function in kidney transplant recipients: a propensity-adjusted analysis. Am J Transplant. 2015;15:2152–2158.
Cittanova ML, Leblanc I, Legendre C, et al. Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;348:1620–1622.
Reinhart K, Perner A, Sprung CL, et al. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012;38:368–383.