Anesthetic considerations in pancreas transplantation based on a 1-year review

To elucidate the anesthetic and perioperative problems in patients who receive a pancreas transplant, the charts and anesthetic records of 55 patients who underwent this operation were retrospectively reviewed. The tracheas of 13% of the patients were difficult to intubate. Intraoperative hyperglycemia (>250 mg/dL) occurred in 54% of the patients, but only 2% developed hypoglycemia (<60 mg/dL). Hyperglycemia resolved in most patients following reperfusion of the pancreatic allograft. Intraoperative hypotension (22%), metabolic acidosis (29%), metabolic alkalosis (14%), and hypokalemia (33%) were also common. However, no patient died within 48 hours of surgery and there were no perioperative myocardial infarctions. Anesthesiologists can help ensure graft function by optimizing the hemodynamic and metabolic status of patients undergoing pancreas transplantation.