Skip to main content Accessibility help
  • Print publication year: 2012
  • Online publication date: November 2012

Chapter 23 - Anesthesia for face transplantation

from Section 3 - Anesthesia for head and neck surgery


The terms neck dissection and laryngectomy describe a wide variety of surgical procedures that attempt to remove a cancer and its main route of spread. Neck dissection is commonly performed during laryngectomy for cancer to prevent and treat any local spread of the primary disease. A careful airway evaluation is an essential part of preparation for a patient undergoing laryngectomy with neck dissection. The treatment of laryngeal cancer has three primary goals: tumor removal, prevention of spread and recurrence, and preservation of organ function (phonation and swallowing) where possible. Neck radiation changes can make airway management difficult as its presence is an independent predictor of failure for both bag-mask ventilation and GlideScope intubation. Systolic blood pressure variation of the arterial line tracing can help guide fluid replacement. Alternatively a central line, at a different location from the neck dissection, can be used.


1. PomahacB, PribazJ, ErikssonE, et al. Three patients with full facial transplantation. N Engl J Med 2011 Dec 28. [Epub ahead of print] PubMed PMID: 22204672.
2. HevesiZG, LopukhinSY, AngeliniG, et al. Supportive care after brain death for the donor candidate. Int Anesthesiol Clin 2006;44:21–34.
3. VenkateswaranRV, PatchellVB, WilsonIC, et al. Early donor management increases the retrieval rate of lungs for transplantation. Ann Thorac Surg 2008;85:278–86.
4. ShahVR. Aggressive management of multiorgan donor. Transplant Proc 2008;40:1087–90.
5. DuBoseJ, SalimA. Aggressive organ donor management protocol. J Intensive Care Med 2008;23:367–75.
6. CywinskiJB, DoyleDJ, KuszaK. Anesthetic care for face transplantation. In SiemionowMZ, ed. The Know How of Face Transplantation. London: Springer; 2011. pp. 95–102.
7. American Society of Anesthesiologists (2005) Standards for basic anesthetic monitoring. American Society of Anesthesiologists.; available from Accessed May 14, 2010.
8. MarikPE, CavallazziR, VasuT, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med 2009;37:2642–7.
9. MakiDG, KlugerDM, CrnichCJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81:1159–71.
10. GannM Jr, SardiA. Improved results using ultrasound guidance for central venous access. Am Surg 2003;69:1104–7.
11. RenardD, DutrayA, RemyA, et al. Subacute combined degeneration of the spinal cord caused by nitrous oxide anaesthesia. Neurol Sci 2009;30:75–6.
12. AdamsJ, CharltonP. Anaesthesia for microvascular free tissue transfer. Br J Anaesth (CEPD Reviews) 2003;3: 33–7.
13. KuszaK, SiemionowM, NalbantogluU, et al. Microcirculatory response to halothane and isoflurane anesthesia. Ann Plast Surg 1999;43:57–66.
14. SigurdssonGH, BanicA, WheatleyAM, et al. Effects of halothane and isoflurane anaesthesia on microcirculatory blood flow in musculocutaneous flaps. Br J Anaesth 1994;73:826–32.
15. HagauN, LongroisD. Anesthesia for free vascularized tissue transfer. Microsurgery 2009;29:161–7.
16. LiuX, PeterFW, BarkerJH, et al. Leukocyte-endothelium interaction in arterioles after ischemia and reperfusion. J Surg Res 1999;87:77–84.
17. KuszaK, BlaszykM, SiemionowM, et al. Alteration in peripheral microcirculatory haemodynamics of muscle flaps during propofol infusion anaesthesia. Anesth Intens Care 2002;34:187–93.
18. HolzmannA, SchmidtH, GebhardtMM, et al. Propofol-induced alterations in the microcirculation of hamster striated muscle. Br J Anaesth 1995;75:452–6.
19. BrookesZL, BrownNJ, ReillyCS. The dose-dependent effects of fentanyl on rat skeletal muscle microcirculation in vivo. Anesth Analg 2003;96:456–62.
20. MarxG, SchuerholzT. Fluid-induced coagulopathy: does the type of fluid make a difference?Crit Care 2010;14:118.
21. American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology 2006;105:198–208.
22. TriulziDJ. The art of plasma transfusion therapy. Transfusion 2006;46(8):1268–70.
23. American Society of Anesthesiologists Committee on Transfusion Medicine. Questions and Answers About Blood Management, 4th edn. American Society of Anesthesiologists; 2008;
24. BuxJ. Transfusion-related acute lung injury (TRALI): a serious adverse event of blood transfusion. Vox Sang 2005;89(1):1–10