The Role Of The Anesthesiologist In Organ Procurement

The anesthesiologist has an important role in organ procurement mainly regarding hemodynamic instability.4 Spinal reflexes can be present after brain death and muscle relaxants are reserved for the operation.

During organ retrieval, maintenance of cardiac output and adequate oxygenation are of great importance. Careful fluid and electrolyte replacement and monitoring of cardiovascular status is critical. Donors may be dehydrated because of fluid restriction and diuretics that were given in an effort to control brain edema before declaring brain death. Hypotension and oliguria should be treated by fluid replacement, often monitored by a central venous pressure line. Packed red blood cells may be used if the hematocrit is less than 21% or hypotension does not respond to intravenous fluids. A urine output of 1 mL/kg/h should be maintained. For hypotension that is not responding to volume challenge, dopamine can be used. Norepinephrine and epinephrine should be avoided as much as possible, and considered only when adequate volume resuscitation and dopamine fail to maintain blood pressure.

Maintenance of body temperature is important. Because of impaired hypothalamic thermoregulation, donors may become hypothermic. Warming of all intravenous fluids and blood products and the use of a warming blanket may help in preventing hypothermia.

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