04 Jul 10

Evidence-based guideline update: Determining brain death in adults

Posted in Transplantation at 0:18 by Laci

By E Wijdicks, P Varelas, G Gronseth and D Greer

Neurology 2010;74:1911-1918

To provide an update of the 1995 American Academy of Neurology guideline with regard to the following questions: Are there patients who fulfill the clinical criteria of brain death who recover neurologic function? What is an adequate observation period to ensure that cessation of neurologic function is permanent? Are complex motor movements that falsely suggest retained brain function sometimes observed in brain death? What is the comparative safety of techniques for determining apnea? Are there new ancillary tests that accurately identify patients with brain death?

Methods
A systematic literature search was conducted and included a review of MEDLINE and EMBASE from January 1996 to May 2009. Studies were limited to adults.

Results and recommendations
In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter. Complex-spontaneous motor movements and false-positive triggering of the ventilator may occur in patients who are brain dead. There is insufficient evidence to determine the minimally acceptable observation period to ensure that neurologic functions have ceased irreversibly. Apneic oxygenation diffusion to determine apnea is safe, but there is insufficient evidence to determine the comparative safety of techniques used for apnea testing. There is insufficient evidence to determine if newer ancillary tests accurately confirm the cessation of function of the entire brain.

07 Oct 06

Anaesthesia for hepatic transplantation

Posted in Anesthesia, Transplantation at 9:15 by Laci

By D Fabbroni, M Bellamy

Contin Educ Anaesth Crit Care Pain 2006 6: 171-175

  • Liver transplantation is the treatment of choice for end-stage liver failure.
  • Pre-assessment and careful patient selection should be performed by a multidisciplinary, anaesthetic, surgical and hepatology team.
  • There are three phases in the physiology of a transplant (resection or ‘pre-anhepatic’ phase, anhepatic phase and post-reperfusion phase). These must be understood and managed appropriately.
  • Blood loss is unpredictable; it can be insignificant or massive.
  • Perioperative care should be provided in an appropriate level 3 facility.

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