The complexity of transplant surgeries requires the expertise and specialty of a transplant anesthesiologist who is an integral part of the transplant team. Transplant anesthesiologists have an extensive background in critical care medicine, cardiac anesthesiology and/or pediatric anesthesiology. This type of anesthesiologist also provides consultation in both the perioperative and intraoperative stages of care.
Since transplant recipients are often the most critically ill patients, it is important that transplant anesthesiologists are experts in administering anesthetics to medically compromised patients. A safe anesthetic for a healthy patient could be potentially dangerous to a transplant recipient. It also is important that transplant anesthesiologists work closely with others on the transplant team to closely manage the recipients’ vital life functions before, during and after the transplant occurs. After surgery, transplant anesthesiologists and intensivists often monitor transplant recipients in the ICU and provide any pain management during the recovery process.
Complexity of Transplant Anesthesia: Liver Transplants
One example of the complexity of transplant anesthesia is during liver transplants, where the liver must be removed from its multiple connections within the circulatory system. Patients who need liver transplants are more susceptible to other problems that can increase their risk of surgery. Massive blood loss, kidney failure, blood clots and the inability to regulate proper levels of sodium and potassium in the blood are just a few examples of the problems that can occur during this type of transplant.
Due to these risks, liver transplant anesthesiologists must be able to manage not only the recipients’ vital life functions, but also the following:
Blood transfusions since patients in liver failure tend to bleed easily. It is difficult for surgeons to stop bleeding without anesthesiologists present to restore normal coagulation with fresh plasma, platelets and other factors.
Rapid swings in sodium levels during transfusions that could lead to brain damage.
Hypothermia that could depress cardiac function and interfere with normal coagulation.
In addition, transplant anesthesiologists must simultaneously manage numerous other bodily functions to make it possible for surgeons to safely perform this type of operation.
Today, advances in transplant surgeries have been made possible by anesthesiologists and surgeons. Many patients are now awake and able to breathe on their own shortly after receiving a liver transplant.