title: Intraoperative fluid and pharmacologic management and the anesthesiologist's supervisory role for nontraditional technologies during liver transplantation: a survey of US academic centers.
abstract: BACKGROUND
  Volume resuscitation and use of vasoactive medications during liver transplantation has not been systematically assessed. Furthermore, the anesthesiologist's role for intraoperative oversight of technologies such as renal replacement therapy and procedures such as venovenous bypass is poorly defined, and it is unclear if the center's annual transplant frequency affects these practices.
  
  
  METHODS
  We conducted a database analysis of the Liver Transplant Anesthesia Consortium survey 202 that addresses these questions. Data from US academic liver transplant anesthesia programs meeting inclusion criteria were included. Results were categorized by their annual transplant volume.
  
  
  RESULTS
  A representative sample of 66% of all eligible centers contributed to the results. Normal saline among crystalloids and albumin among colloids were the most frequently chosen maintenance and non-blood product volume expansion fluids, with little variation by center size. A large variety of vasoactive agents is routinely utilized across programs, with vasopressors as a cornerstone of hemodynamic support. Large programs seem to use less of these agents compared with lower volume centers.
  
  
  CONCLUSIONS
  Anesthesiologists are increasingly involved in oversight and management of intraoperative renal replacement therapies, venovenous bypass and cell saver devices with rising transplant frequency. This new insight may be indicative of skill sets needed by members of liver transplantation anesthesia teams and should be considered in curriculum design for hepatobiliary transplant anesthesia fellowships.
authors: Tufts Medical Center, Department of Anesthesiology, Tufts University School of Medicine, Boston, Massachusetts 02111, USA. rschumann@tuftsmedicalcenter.org
authors: R
authors: R
authors: Schumann
authors: S
authors: S
authors: Mandell
authors: M D
authors: MD
authors: Michaels
authors: J
authors: J
authors: Klinck
authors: A
authors: A
authors: Walia
mesh_terms: D000046:Academic Medical Centers; D000776:Anesthesiology; D002983:Clinical Competence; D005440:Fluid Therapy / Q000639:trends; D019538:Health Care Surveys; D006801:Humans; D007430:Intraoperative Care; D016031:Liver Transplantation / Q000379:methods* / Q000639:trends; D010348:Patient Care Team; D010819:Physician's Role; D010952:Plasma Substitutes / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000639:trends; D016896:Treatment Outcome; D014481:United States; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents