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Subvalvular aortic stenosis is a progressive left-sided obstructive lesion, usually consisting of a discrete membrane, fibromuscular ridge, or tunnel. Surgical intervention is preferred over catheter intervention when the gradient across the lesion is greater than 40 mm Hg or aortic insufficiency has developed across the aortic valve. Perioperative anesthetic goals include maintaining adequate preload, afterload, and a low to normal heart rate.
This chapter continues the scenario from the chapter on Hepatic Portoenterostomy or Kasai Procedure. The pathophysiology of end stage liver disease is reviewed with its specific effects on the individual organ systems. The authors provide a detailed explanation of the pre-operative evaluation for patients requiring liver transplantation. A detailed description of the 3 main phases of liver transplantation is presented with attention to the related anesthetic considerations.
This chapter provides an overview of the surgical treatment for biliary atresia, the Hepatic Portoenterostomy or Kasai Procedure. The pathophysiology of biliary atresia is reviewed as it related to the organ systems effected. The signs and symptoms of neonatal liver failure are discussed including the development of hepatorenal and hepatopulmonary syndromes. The chapter provides an overview of the surgical aspects and anesthetic concerns related to the Kasai procedure. The chapter provides a segue into the chapter on liver transplantation.
This chapter outlines anesthetic considerations for face transplantation procedure based on the experience of two hospitals where the first face transplants in the United States took place as well as preliminary data from three international centers (personal communication). Careful examination of a patient's airway is critical since it dictates intraoperative airway management plan. The goals and principles of intraoperative fluid management in face transplantation are similar to any other long surgical procedure involving micro-vascular free flaps. Airway management in cases where the composite graft involves maxillary or mandibular structures may present a significant challenge: the forces associated with direct laryngoscopy for intubation could conceivably cause damage to incompletely healed bony structures. The duration and complexity of the face transplant operation requires participation of multiple teams, including more than one anesthesia team.