BUMC Basics.pdf - Anesthesia Home

Liver transplant
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Liver transplant evaluation (LTE)
▪ Can only be initiated by a hepatologist.
▪ Standardized 3 page order set which includes an
extensive battery of imaging studies, labs, and consults.
The evaluation usually takes 2-3 days minimum to
complete. The liver transplant coordinator calls the
consults (Psychiatry, etc.) as the transplant service often
has consultants that they prefer to use.
▪ Be careful what you tell families and patients about their
candidacy for transplant. Remember that the decision to
transplant a patient is a committee decision. In general
always defer this to the hepatologist. Patients and families
are sometimes under the impression that they are being
sent to Baylor for a liver transplant. It is important to tell
the patient and family that a liver transplant evaluation is
required first.
▪ Once a patient is transplanted, it is usually okay to sign
off as the transplant surgery team will completely manage
the patient.
General liver patient guidelines
• Avoid benzodiazepines and narcotics as they can
precipitate encephalopathy
• Tramadol is a good choice for pain management: 50 mg
PO q12 hours prn pain
• Insomnia is very prevalent. It is best to use Trazodone
for insomnia. Do not use Ambien, Lunesta, etc. if possible.
• If agitation is a significant problem, then low dose IM
Zyprexa or Haldol is a possible treatment that can be
used.
• Always notify the liver transplant service if a patient that
is on the liver transplant list is hospitalized.
GI STUDIES
Study Orders
• Abdominal US (NPO 6hrs prior)
• Barium Swallow (NPO 1hr prior)
• Upper GI (NPO after MN)
• SBFT (NPO after MN and one glass of water qhr from
noon to 1900)