Anaesthetic management of bilateral hand transplantation
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Vascularised composite tissue allotransplantation is now considered a feasible reconstructive option for patients with upper extremity loss. We are reporting the anaesthetic management of the first hand transplantation in India. A 31 year-old male patient who lost both his hands in a train accident was put on the waiting list of the transplant programme 2 years back. Donor became available when the family of a 24 year-old healthy male patient, diagnosed to be brain dead, came forward with the willingness to donate both his hands.Pre-operatively, the recipient received tacrolimus, mycophenolate mofetil and valganciclovir orally. Under local anaesthesia, right sub-clavian central line, right dorsalis pedis arterial line and two 16 G peripheral lines in the feet were introduced. Thymoglobulin 1 mg/kg, methylprednisolone 500 mg and piperacillin/tazobactam 4.5 g were given intravenously.The hand harvesting was performed under tourniquet and the limbs were perfused with cold HDK solution through the brachial vessels before amputation. Other organs were harvested only after the hand harvesting was done. The recipient received a standard anaesthesia protocol: induction with propofol, pancuronium for muscle relaxation, morphine as analgesic, maintenance with oxygen and nitrous oxide (1:2) with isoflurane (1%), and mechanical ventilation. Supra-clavicular brachial plexus catheters were placed bilaterally with the aid of an ultrasound probe and 10 ml bupivacaine 0.25% was given on each side...

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