Anesthetic Management in Composite Tissue Transplantation (Hands, Face and Legs)

Background The main problem for ideal anesthetic managment of composite tissue transplantation CTT is the little experience and limited literature Methods We report our experience in bilateral hand transplants face transplant and bilateral leg transplant performed during the period men and woman aged years In the first case bilateral hands rapid sequence induction and anesthesia maintenance with propofol remifentanil and rocuronium was performed The rest of cases were protocolized to balanced anesthesia with sevofluorane remifentanyl and cisatracurium Results The mean duration per intervention was h SD h Only the first hand transplant required dopamine Fluid replacement and blood derivatives per intervention was SD mL of crystalloids SD mL of colloids SD CH SD FFP SD of platelet pool and SD g of fibrinogen Only the first case had bleeding and coagulopathy with a Hb of g dL requiring repeat surgery Mean extubation time was h SD h including the hand transplant patient that had been tracheotomized Postoperative analgesia was controlled with NSAIDs and PCA morphine Discharge to the ward was performed at h except for discharge at h Conclusion CTT involves complex techniques with blood loss hypovolemia and coagulopathy We recommend a balanced anesthetic technique with invasive hemodynamic monitoring placement of a high flow central line frequent serial laboratory tests ABG TEG and maintenance of adequate graft flow