TRANSPLANT ANESTHESIA
GOALS AND OBJECTIVES
CA2 Level
DEFINITION
This rotation is a one month rotation that will provide CA-2 residents with an advanced
understanding of end-stage liver disease and its treatment through hepatic vascular procedures
and liver transplantation. Also, this rotation will further develop CA-2 consultant level skills for
patients with end-stage liver disease and co-existing medical conditions.
CURRICULUM
The Transplant Anesthesia rotation is intended to provide CA-2 residents the opportunity to care
for multiple patients undergoing liver transplantation with varying degrees of end-stage liver
disease. Exposure to both preoperative and postoperative care of these patients will occur in
addition to intraoperative management.
MEDICAL KNOWLEDGE
At the conclusion of this rotation, the resident should be able to describe:
1.
2.
3.
4.
5.
6.
7.
the pathophysiology of end-stage liver disease.
the goals and objectives of preparing patients for liver transplantation
preoperatively.
the intraoperative management of patients undergoing liver transplantation.
the management of massive infusion.
intraoperative thromboelastograms and provide rationale for treatment of
observed coagulation defects.
the goals and objectives of ICU care in the immediate post-liver transplant period.
the perioperative management of patients with acute fulminant hepatic failure
(with and without elevated ICP).
PATIENT CARE
At the conclusion of this rotation, the resident should be able to:
1.
2.
3.
4.
assemble and organize equipment, drugs, and supplies necessary to perform an
anesthetic for liver transplantation.
perform anesthetic induction and maintenance for patients undergoing liver
transplantation.
place invasive hemodynamic monitors including radial and femoral arterial lines
and central venous catheters..
place large bore intravenous access lines including 7F and 8.5F rapid infusion
catheters.
5.
6.
7.
8.
manage intraoperative blood loss via massive transfusion using the Rapid Infusion
System™.
manage on-going intraoperative coagulopathy.
manage post-reperfusion syndrome when encountered.
understand the use of TEE in selected liver transplant patients
COMMUNICATION AND INTERPERSONAL SKILLS
At the conclusion of this rotation, the resident will:
1.
2.
3.
collect appropriate information about in-house patients on the list waiting for
donors.
interface with the transplant coordinator and the liver team to schedule cases.
communicate with in-house call teams to prepare the O.R. for OLT and assure the
readiness of the patient after admission.
PROFESSIONALISM
At the conclusion of this rotation, the resident should must:
1.
2.
be fully ready for an OLT case or a living-related transplant (either donor or
recipient).
participate in the Liver Team call coverage completely.
Rev. 7/2009
2