Episode 39: Liver Transplant with Dr. Steve Frank

The podcast explores the complexities of liver transplant anesthesia, addressing the reasons for needing transplants, such as viral hepatitis, alcoholic cirrhosis, and NASH. It highlights the necessity of specialized training for anesthesiologists due to the patients' compromised health and the operations' high-risk nature, including significant blood loss. The discussion covers managing abnormal cardiovascular physiology, like high cardiac output and low systemic vascular resistance, and addressing hepatorenal syndrome. Dr. Steven Frank explains the three stages of liver transplantation: hepatectomy, anhepatic, and post-reperfusion, detailing concerns like blood loss, coagulation issues, acidosis, and hyperkalemia, along with corresponding management strategies.

Outlines

Part 1: Introduction, Context

Part 2: Pre-Operative Preparation, Equipment

Part 3: Monitoring, Vascular Access

Part 4: Surgical Stages, Fluid Management

Part 5: Intra-Operative Challenges, Reperfusion

Part 6: Post-Reperfusion, Coagulation Control

Part 7: ICU, Recovery, Conclusion

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Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: Introduction, Context

FIGS Scrubs: Comfort and Style for Healthcare Professionals with Discount Code

Introduction to Liver Transplant Anesthesia with Dr. Steven Frank

Common Causes for Liver Transplantation: Viral Hepatitis, Alcohol, and NASH

Liver Transplant Eligibility: Abstinence Rules and MELD Score Prioritization

Part 2: Pre-Operative Preparation, Equipment

Liver Transplant Anesthesia: A Challenging Field Requiring Specialized Training

Hepatorenal Syndrome: Renal Failure Reversible with Liver Transplant

Preparing the Operating Room for Liver Transplantation: Equipment and Medications

Blood Product Ordering and Coagulation Management During Liver Transplant

Part 3: Monitoring, Vascular Access

Epinephrine Use in Liver Transplant: Bolus Doses for Reperfusion Hypotension

Invasive Line Placement: Arterial, Central Venous, and Rapid Infusion Catheters

Pressor Selection: Alpha Agonists for High Output, Low Resistance Physiology

TEE vs. Swan-Ganz: Assessing Cardiac Function and Volume Status

Part 4: Surgical Stages, Fluid Management

Liver Transplant Stages: Hepatectomy, Anhepatic, and Post-Reperfusion

Fluid Management: Blood for Blood, Minimizing Crystalloid, Considering Albumin

Albumin Use for Ascites Removal: Maintaining Pulmonary Artery Diastolic Pressure

Part 5: Intra-Operative Challenges, Reperfusion

Anhepatic Phase: Worsening Coagulopathy and Fibrinolysis Management

Pressor Management During Anhepatic Phase: Maintaining Cardiac Output and SVR

Coagulopathy and Acidosis During Anhepatic Phase: Gut Ischemia Concerns

Reperfusion: Acidosis and Hyperkalemia Management with Calcium and Bicarbonate

Hyperkalemic Arrest During Reperfusion: Potassium Bolus to the Heart

Part 6: Post-Reperfusion, Coagulation Control

Potassium Reduction Strategies and Post-Reperfusion Coagulation Management

Avoiding Factor VII and Managing Hypercoagulable Patients with Heparin

Part 7: ICU, Recovery, Conclusion

Post-Operative ICU Management: Monitoring Bleeding, Acidosis, and Lactate

Base Deficit vs. Lactate Level: Indicators of Hepatic and Renal Function

Concluding Remarks and Listener Engagement

Episode 39: Liver Transplant with Dr. Steve Frank

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Part 1: Introduction, Context

00:00FIGS Scrubs: Comfort and Style for Healthcare Professionals with Discount Code

FIGS Scrubs: Comfort and Style for Healthcare Professionals with Discount Code

01:08Introduction to Liver Transplant Anesthesia with Dr. Steven Frank

Introduction to Liver Transplant Anesthesia with Dr. Steven Frank

02:09Common Causes for Liver Transplantation: Viral Hepatitis, Alcohol, and NASH

Common Causes for Liver Transplantation: Viral Hepatitis, Alcohol, and NASH

03:38Liver Transplant Eligibility: Abstinence Rules and MELD Score Prioritization

Liver Transplant Eligibility: Abstinence Rules and MELD Score Prioritization

Part 2: Pre-Operative Preparation, Equipment

05:30Liver Transplant Anesthesia: A Challenging Field Requiring Specialized Training

Liver Transplant Anesthesia: A Challenging Field Requiring Specialized Training

08:15Hepatorenal Syndrome: Renal Failure Reversible with Liver Transplant

Hepatorenal Syndrome: Renal Failure Reversible with Liver Transplant

11:14Preparing the Operating Room for Liver Transplantation: Equipment and Medications

Preparing the Operating Room for Liver Transplantation: Equipment and Medications

12:43Blood Product Ordering and Coagulation Management During Liver Transplant

Blood Product Ordering and Coagulation Management During Liver Transplant

Part 3: Monitoring, Vascular Access

14:24Epinephrine Use in Liver Transplant: Bolus Doses for Reperfusion Hypotension

Epinephrine Use in Liver Transplant: Bolus Doses for Reperfusion Hypotension

15:25Invasive Line Placement: Arterial, Central Venous, and Rapid Infusion Catheters

Invasive Line Placement: Arterial, Central Venous, and Rapid Infusion Catheters

17:32Pressor Selection: Alpha Agonists for High Output, Low Resistance Physiology

Pressor Selection: Alpha Agonists for High Output, Low Resistance Physiology

18:44TEE vs. Swan-Ganz: Assessing Cardiac Function and Volume Status

TEE vs. Swan-Ganz: Assessing Cardiac Function and Volume Status

Part 4: Surgical Stages, Fluid Management

20:25Liver Transplant Stages: Hepatectomy, Anhepatic, and Post-Reperfusion

Liver Transplant Stages: Hepatectomy, Anhepatic, and Post-Reperfusion

23:49Fluid Management: Blood for Blood, Minimizing Crystalloid, Considering Albumin

Fluid Management: Blood for Blood, Minimizing Crystalloid, Considering Albumin

26:39Albumin Use for Ascites Removal: Maintaining Pulmonary Artery Diastolic Pressure

Albumin Use for Ascites Removal: Maintaining Pulmonary Artery Diastolic Pressure

Part 5: Intra-Operative Challenges, Reperfusion

29:03Anhepatic Phase: Worsening Coagulopathy and Fibrinolysis Management

Anhepatic Phase: Worsening Coagulopathy and Fibrinolysis Management

31:10Pressor Management During Anhepatic Phase: Maintaining Cardiac Output and SVR

Pressor Management During Anhepatic Phase: Maintaining Cardiac Output and SVR

32:29Coagulopathy and Acidosis During Anhepatic Phase: Gut Ischemia Concerns

Coagulopathy and Acidosis During Anhepatic Phase: Gut Ischemia Concerns

34:20Reperfusion: Acidosis and Hyperkalemia Management with Calcium and Bicarbonate

Reperfusion: Acidosis and Hyperkalemia Management with Calcium and Bicarbonate

35:55Hyperkalemic Arrest During Reperfusion: Potassium Bolus to the Heart

Hyperkalemic Arrest During Reperfusion: Potassium Bolus to the Heart

Part 6: Post-Reperfusion, Coagulation Control

38:21Potassium Reduction Strategies and Post-Reperfusion Coagulation Management

Potassium Reduction Strategies and Post-Reperfusion Coagulation Management

40:47Avoiding Factor VII and Managing Hypercoagulable Patients with Heparin

Avoiding Factor VII and Managing Hypercoagulable Patients with Heparin

Part 7: ICU, Recovery, Conclusion

42:33Post-Operative ICU Management: Monitoring Bleeding, Acidosis, and Lactate

Post-Operative ICU Management: Monitoring Bleeding, Acidosis, and Lactate

44:32Base Deficit vs. Lactate Level: Indicators of Hepatic and Renal Function

Base Deficit vs. Lactate Level: Indicators of Hepatic and Renal Function

48:25Concluding Remarks and Listener Engagement

Concluding Remarks and Listener Engagement