Anesthesiology clinics of North America
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Anesthesiol Clin North America · Dec 2004
ReviewThe transplant recipient for nontransplant surgery.
The transplant recipient has traded a life-threatening illness for a chronically immunosuppressed state. Subsequent anesthetic management for non-transplant surgical procedures may be challenging. The anesthesia provider must be aware of the degree of post-transplant organ dysfunction and alter anesthesia techniques accordingly. This article reviews the anesthetic concerns for patients who have undergone a variety of organ transplants.
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Liver transplantation offers patients with liver disease an optimal chance for long-term survival. Current indications, preoperative assessment, patient selection, intraoperative anesthetic management and outcomes are described. ⋯ This demand, coupled with a nonexpanding supply of deceased donor organs, has resulted in a shortage of grafts and prolonged waiting times. Novel solutions using segmental liver grafts from living donors, and the challenges associated with this approach, are discussed.
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Anesthesiol Clin North America · Dec 2004
ReviewAnesthetic considerations for multivisceral transplantation.
Multivisceral transplantation is defined as the en bloc transplantation of three or more abdominal organs. Although multivisceral transplant recipients do not yet enjoy the same survival rates as renal and liver transplant recipients, this procedure can be life saving and has shown improvements in survival rates over time. Advances in immunosuppression hold promise for the future of multivisceral transplantation.
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Anthrax is an often fatal bacterial infection that occurs when Bacillus anthracis endospores enter the body through one of three major routes: inhalational, cutaneous, or gastrointestinal. Before the anthrax terrorist attacks in the United States in 2001, there was very little interest in anthrax as a serious human pathogen; anthrax was viewed mainly as a veterinarian problem of minor importance, with most cases attributed to occupational exposure. ⋯ Many, if not most patients, would require some degree of critical care in the form of ventilator or hemodynamic support. It is for this reason that anesthesiologists and other critical care physicians have specific knowledge of the diagnosis, treatment, and prevention of anthrax.
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This article discusses the current state of minimally invasive treatment options for a variety of vascular diseases. Advances that have been introduced over the last two decades have dramatically changed the practice of vascular surgery and anesthesia. The ability to treat pathology, using both intraluminal and extraluminal means,has provided vascular surgeons, interventional radiologists, and cardiologists with unique treatment options that were not available less than a decade ago. Peripheral interventions to treat vascular disease have exploded, from 90,000 in 1994 to more than 200,000 in 1997, and endovascular procedures now replace almost 50% of traditional open vascular operations.