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Laporte CCM, Brown B, Wilke TJ, Kassel CA. 2023 Clinical Update in Liver Transplantation. J Cardiothorac Vasc Anesth 2024; 38:1390-1396. [PMID: 38490899 DOI: 10.1053/j.jvca.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/17/2024]
Abstract
Liver transplantation continues to provide life-saving treatment for patients with end-stage liver disease. Advances in the field of transplant anesthesia continue to support the care of more complex patients. The use of extracorporeal membrane oxygenation has been described in critical care settings and cardiac surgery but may be a valuable option for specific conditions for patients undergoing liver transplantation. Changes to the allocation process for liver grafts now focus on acuity circles to reduce regional disparities. As the number of life-saving transplant surgeries increases, so does the need for specialty knowledge in the anesthetic considerations of these procedures. The specialty of transplant anesthesia continues to grow and develop to meet the demands of complex patients and the increased number of transplants performed. Liver transplantation can be a resource-demanding procedure, and predicting the need for massive transfusion can aid in planning and preparing for significant blood loss.
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Affiliation(s)
| | - Brittany Brown
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Trevor J Wilke
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE
| | - Cale A Kassel
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE.
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Maffucci P, Smith NK, Zerillo J, Baron E, Katz D, Burnett GW. The use of simulation in liver transplantation anesthesiology fellowship training: A survey of fellowship program directors in the United States. Clin Transplant 2023; 37:e15055. [PMID: 37398991 DOI: 10.1111/ctr.15055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/20/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Liver transplantation surgeries are challenging cases for anesthesiologists. While intra-operative teaching is paramount, simulation has emerged as an educational tool to augment clinical training. A variety of simulation modalities have been described in the literature, but no study has aimed to assess the use of simulation in liver transplantation fellowship training. METHODS A 20-question survey detailing the use of simulation, including simulation modalities used and barriers to simulation use, was developed and distributed to 22 program directors for liver transplantation anesthesiology fellowships. An exploratory analysis was performed on multiple-choice and free-text responses. RESULTS Thirteen program directors completed the survey and were included in our analysis. Most programs (61.5%) did not report the use of simulation for liver transplantation fellow training. Of the programs that did use simulation, four required it as a mandatory component of their curriculum. Task trainers and screen-based simulators were more commonly used by these programs. Faculty availability and interest, as well as a lack of an established curriculum, were cited as major limitations to simulation use. CONCLUSIONS Simulation is an important component of anesthesiology trainee education, as evidenced by the requirement for simulation during residency by the American Council for Graduate Medical Education. Our findings suggest that simulation is an underutilized educational tool that we believe could greatly augment the training of liver transplantation anesthesiology fellows by providing exposure to a wide range of clinical challenges.
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Affiliation(s)
- Patrick Maffucci
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Jeron Zerillo
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elvera Baron
- Department of Anesthesiology, Case Western Reserve University School of Medicine at Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Daniel Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
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Nguyen-Buckley C, Bezinover DS, Bhangui P, Biancofiore G, Blasi A, Chadha R, Pustavoitau A, Sabate A, Saner FH, Wagener G, Wray CL, Zerillo J, Pan TLT. International Liver Transplantation Society/Society for Advancement of Transplant Anesthesia Consensus Statement on Essential Attributes of a Liver Transplant Anesthesiologist. Transplantation 2023; 107:1427-1433. [PMID: 36944597 DOI: 10.1097/tp.0000000000004583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND We sought to establish consensus on the essential skills, knowledge, and attributes that a liver transplant (LT) anesthesiologist should possess in a bid to help guide the further training process. METHODS Consensus was achieved via a modified Delphi methodology, surveying 15 identified international experts in the fields of LT anesthesia and critical care. RESULTS Key competencies were identified in preoperative management and optimization of a potential LT recipient; intraoperative management, including hemodynamic monitoring; coagulation and potential crisis management; and postoperative intensive and enhanced recovery care. CONCLUSIONS This article provides an essential guide to competency-based training of an LT anesthesiologist.
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Affiliation(s)
- Christine Nguyen-Buckley
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Medical Center, Los Angeles, CA
| | - Dmitri S Bezinover
- Department of Anesthesiology, University of Pennsylvania, Pennsylvania, PA
| | - Pooja Bhangui
- Department of Liver Transplant Anesthesia, Medanta-The Medicity, Delhi-N.C.R., India
| | - Gianni Biancofiore
- Department of Transplant Anesthesia and Critical Care, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Annabel Blasi
- Anesthesia Department, Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain
| | - Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Jacksonville, Jacksonville, FL
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Antoni Sabate
- University Hospital of Bellvitge, Barcelona University, Barcelona, Spain
| | - Fuat H Saner
- Department of General, Visceral-, and Transplantation Surgery, Essen University Medical Center, Essen, Germany
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Christopher L Wray
- Department of Anesthesiology and Perioperative Medicine, University of California at Los Angeles Medical Center, Los Angeles, CA
| | - Jeron Zerillo
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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McKevitt H, Milan Z. A Case of Difficult Arterial Cannulation: Is Intra-Arterial Blood Pressure Monitoring an Absolute Requirement for Paediatric Liver Transplantation? J Clin Med 2023; 12:4387. [PMID: 37445424 DOI: 10.3390/jcm12134387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Invasive arterial blood pressure monitoring is the standard of practice in terms of intraoperative blood pressure surveillance during liver transplantation. While this is an ideal, achieving reliable arterial access can be extremely challenging in the paediatric and neonatal population, repeated attempts at arterial cannulation are not without risk and alternative best practice means of haemodynamic monitoring are not clearly established. We describe a case of paediatric liver transplantation in a 3.9 kg infant that was complicated by difficult arterial cannulation, and we suggest that, when reasonable attempts to achieve intra-arterial access have failed, it is safe to proceed with paediatric liver transplantation with non-invasive blood pressure monitoring at 2 min intervals throughout the case and 1 min intervals at reperfusion. We recognise the unique technical challenges in paediatric liver transplant anaesthesia, and we advocate for the establishment of formal clinical training competencies in line with adult practice recommendations. We recommend the use of the Seldinger technique under ultrasound guidance as a first-line approach when difficult arterial cannulation is anticipated, and we discuss techniques for alternative approaches. We suggest that additional alternative means of haemodynamic monitoring should be considered when arterial access cannot be established; however, as no method demonstrates absolute superiority, one or a combination of techniques should be considered, depending on local availability and expertise.
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Affiliation(s)
- Helen McKevitt
- Department of Anaesthesia, Kings College Hospital, London SE5 9RS, UK
| | - Zoka Milan
- Department of Anaesthesia, Kings College Hospital, London SE5 9RS, UK
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Abrams B, Kowalsky M, Weitzel N, Kertai MD. Cardiac Anesthesiology - Paving the Way across Multiple Subspecialties. Semin Cardiothorac Vasc Anesth 2022; 26:5-7. [PMID: 35152793 DOI: 10.1177/10892532221076655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Benjamin Abrams
- Department of Anesthesiology, University of Colorado, Denver, CO, USA
| | - Markus Kowalsky
- Cardiothoracic Anesthesiology, Department of Anesthesiology, University of Colorado, Denver CO, USA
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado School of Medicine, Denver, CO, USA
| | - Miklos D Kertai
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
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Souki FG, Chadha R, Planinsic R, Zerillo J, Nguyen-Buckley C, Smith N, Mandell MS, Sakai T, Nicolau-Raducu R. Recommendations From the Society for the Advancement of Transplant Anesthesiology Fellowship Committee: Core Competencies and Milestones for the Kidney/Pancreas Component of Abdominal Organ Transplant Anesthesia Fellowship. Semin Cardiothorac Vasc Anesth 2021; 26:15-26. [PMID: 34872395 DOI: 10.1177/10892532211058574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Society for the Advancement of Transplant Anesthesia (SATA) is dedicated to improving patient care in all facets of transplant anesthesia. The anesthesia fellowship training recommendations for thoracic transplantation (heart and lungs) and part of the abdominal organ transplantation (liver) have been presented in previous publications. The SATA Fellowship Committee has completed the remaining component of abdominal transplant anesthesia (kidney/pancreas) and has assembled core competencies and milestones derived from expert consensus to guide the education and overall preparation of trainees providing care for kidney/pancreas transplant recipients. These recommendations provide a comprehensive approach to pre-operative evaluation, vascular access procedures, advanced hemodynamic monitoring, assessment of coagulation and metabolic abnormalities, operative techniques, and post-operative pain control. As such, this document supplements the current liver/hepatic transplant anesthesia fellowship training programs to include all aspects of "Abdominal Organ Transplant Anesthesia" recommended knowledge.
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Affiliation(s)
- Fouad G Souki
- Department of Anesthesiology, 12235University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Ryan Chadha
- Department of Anesthesiology, 23389Mayo Clinic, Jacksonville, FL, USA
| | - Raymond Planinsic
- Department of Anesthesiology, 6595University of Pittsburgh Medical Center, Pittsburgh, AR, USA
| | - Jeron Zerillo
- Department of Anesthesiology, 5944Mount Sinai Medical Center, New York, NY, USA
| | | | - Natalie Smith
- Department of Anesthesiology, 5944Mount Sinai Medical Center, New York, NY, USA
| | - M Susan Mandell
- Department of Anesthesiology, 129263University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Tetsuro Sakai
- Department of Anesthesiology, 6595University of Pittsburgh Medical Center, Pittsburgh, AR, USA
| | - Ramona Nicolau-Raducu
- Department of Anesthesiology, 12235University of Miami, Jackson Memorial Hospital, Miami, FL, USA
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Standardization of Neuroanesthesia Education: Need of the Hour and the Way Forward. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:467-476. [PMID: 34720755 PMCID: PMC8546382 DOI: 10.1007/s40140-021-00477-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/15/2022]
Abstract
Purpose of Review This review illustrates the evolution and progress with standardization of fellowship education in neuroanesthesiology. It provides a structured discussion around the need for curricula and framework which individual training programs in neuroanesthesiology can use to meet defined educational standards thus meeting criteria for accreditation. Recent Findings Neuroanesthesiology training has traditionally been heterogenous around the world but international efforts from the community of neuroanesthesiology have culminated in the development of an international council for perioperative training in neuroscience in anesthesiology(ICPNT). This serves not only as an accrediting body but also creates a platform through their neuroanesthesia program relations committee for collaboration and engagement between various training programs internationally, increasing the educational standards of the individual programs and collectively increasing the overall level of standards for neuroanesthesia training. Standardized curriculum and competency-based assessments and milestones would help with narrowing the focus to quality education in neuroanesthesiology. Summary Structured training around the three pillars of neuroanesthesiology with concomitant accreditation is expected to lead to higher education standards with better patient care. The SNACC created milestones for neuroanesthesiology training during residency and the ICPNT can now use this as a foundation for fellowship training. Having a council to accredit and standardize will likely become indispensable in creating a set path for training in neuroanesthesiology. Additionally, the flexibility built in due to the international nature would allow modified and variable pathways depending upon individual capabilities and interests. The path forward will include widespread adoption of standardization supporting the overarching goal of excellent patient outcomes around the world.
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Mandell MS, Sakai T, Wagener G, De Marchi L, Subramaniam K, JHuang J, Hendrickse A, Deshpande R, Ryan C, Pretto EA. The Society for the Advancement of Transplant Anesthesia (SATA) enters a new partnership with Clinical Transplantation. Clin Transplant 2021; 35:e14203. [PMID: 33475197 DOI: 10.1111/ctr.14203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/30/2022]
Affiliation(s)
- M Susan Mandell
- Department of Anesthesiology, University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Lorenzo De Marchi
- Department of Anesthesiology, MedStar-Georgetown University Hospital, Washington, DC, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jiapeng JHuang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY, USA
| | - Adrian Hendrickse
- Department of Anesthesiology, University of Colorado Anschutz Medical Center, Denver, CO, USA
| | - Ranjit Deshpande
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | - Chadha Ryan
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Ernesto A Pretto
- Department of Anesthesiology and Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL, USA
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Del Rio JM, Twite M, Weitzel N, Kertai MD. Driving Paradigms Shifts Is at the Core of Our Specialty. Semin Cardiothorac Vasc Anesth 2019; 23:345-348. [PMID: 31690256 DOI: 10.1177/1089253219881833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J Mauricio Del Rio
- Duke University, School of Medicine, Durham, NC, USA.,Duke University Medical Center, Durham, NC, USA
| | - Mark Twite
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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