Anesthetic and perioperative management for intestinal transplantation

Most patients with irreversible intestinal failure have considerable comorbidities; hence, they are rigorously pre-assessed by a multidisciplinary team to establish cardiovascular fitness, risk profìle, and vascular access strategy. Chronic treatment with TPN may result in chronic vascular thrombosis at various access sites. For this reason, the evaluation of venous access with venous Doppler studies and venous angiography is particularly important during the initial assessment of the patient, because it helps avoiding as much as possible a long and distressing search for a vein in the operating room, which can result in a delay of the start of the procedure and a potential increase of the ischemia time of the graft. Laboratory evaluation for intestinal failure includes complete blood count; assessment of metabolic, acid-base, fluid, electrolyte, and coagulation status (antithrombin III-defìcient patients are more likely to suffer from perioperative thrombotic events); as well as standard liver and renal function tests. Testing of the patient's cardiopulmonary status should include electrocardiogram and chest radiography. A 2D echocardiogram is helpful to screen for gross abnormalities, and if clinically indicated, pulmonary function studies and a dobutamine stress echocardiography should be considered.