Preoperative Preparation

When an operation is planned in advance, preparation of the transplant recipient does not differ substantially from other patients. Maintenance medications, especially the immunosuppressants, antihypertensives and cardiac drugs should be administered with a minimal volume of water. Diabetics should reduce the dose of long and intermediate acting insulin, usually by one half. If hypoglycemia occurs or the start of the operation is delayed, intravenous dextrose must be initiated. When bowel preparation is necessary, preoperative overnight hospital-ization to include intravenous fluids is important to avoid dehydration and the potential for intra- operative hypotension.

Antibiotic prophylaxis is important for invasive procedures transplant recipients might undergo, and therapy should be tailored according to the expected risk of contamination. Penicillin or ampicillin are appropriate for dental procedures, whereas broader spectrum coverage to include gram positive and gram negative bacteria is warranted for intra- abdominal procedures. When the anticipated period of bacteremia is brief and self-limited (e.g., following dental cleaning or laparoscopic cholecystectomy), we recommend initiation of antibiotic coverage just prior to the procedure, continuing for 24 hours afterwards. When ongoing microbial seeding is anticipated, a prosthetic material is implanted, or residual foci of infection or necrotic material might remain, the antibiotic course should be extended (Table E9.1).

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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