Anesthetic management for two cases of living related small bowel transplantation

Isolated small bowel transplantation allows patients with irreversible small bowel failure to be weaned from total parenteral nutrition (TPN). We reported the first two cases of anesthesia for living related donor small bowel transplantation in our hospital. They had required long-term TPN. This resulted in thrombosis of the major blood vessels which critically restricted vascular access available for TPN, leading to a life-threatening condition for the patients. In patients with known difficult vascular access, performing a magnetic resonance imaging before surgery to evaluate patency of central veins seems reasonable, as well as inserting a central catheter before the surgical procedure. Graft reperfusion may cause hemodynamic instability due to changes in potassium, acid-base status as the preservative solution is flushed out of the implant. Hemodynamic, respiratory parameters and urinary output were well preserved throughout the procedure. Besides, a transitory increase in potassium following graft revascularization and biochemical changes were small. Anesthetic management requires comprehensive preoperative assessment and sufficient management without interfering with intestinal function, optimizing splanchnic perfusion to ensure implant viability.