Anaes SAQs · Perioperative medicine
Anaesthesia for the solid organ transplant recipient
Final-examination SAQ for transplant-recipient-anaesthesia.
On this page
Study tools
Target exams
ANZCAFRCAEDAICABAFCAI
Prompt
A 54-year-old kidney transplant recipient (tacrolimus, mycophenolate, prednisolone) needs emergency laparotomy for small bowel obstruction. Outline anaesthetic management priorities.
Model answer
Graft/IS (4). Baseline creatinine/levels; continue essential IS with pharmacy/transplant advice on NBM conversion; stress-dose steroids if indicated.[1]
Risks (3). Infection, aspiration if obstructed, CVD/diabetes comorbidity.[1]
Intraop (4). RSI if indicated; maintain perfusion pressure for graft; avoid NSAIDs/nephrotoxins; careful fluids; asepsis; abx timing.[1]
Drug interactions (2). Caution with CYP3A4 inhibitors interacting with tacrolimus — azoles, macrolides, calcium-channel blockers, grapefruit, rifampicin, St John's wort, protease inhibitors.[1][2]
Postop (2). Restart IS, monitor creatinine, transplant team review.[1]
References2ShowHide
- [1]Herborn J, Parulkar S Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery. Anesthesiol Clin, 2017.PMID 28784225
- [2]Kuypers DR Immunotherapy in elderly transplant recipients: a guide to clinically significant drug interactions. Drugs Aging, 2009.PMID 19728747