Sun Ho-Hyun Brian, Antoine Jill, Vu Giao, Park Chan M
Resident Physician, Division of Oral and Maxillofacial Surgery, Alameda Health System, Highland Hospital, Oakland, CA; Resident Physician, Division of Oral and Maxillofacial Surgery, Dugoni School of Dentistry, University of the Pacific, San Francisco, CA; and Clinical Assistant Professor, Division of Oral and Maxillofacial Surgery, College of Dental Medicine, Western University of Health Sciences, Pomona, CA.
Formerly, Medical Director, Division of Anesthesia Perioperative Clinic, Alameda Health System, Highland Hospital, Oakland, CA.
J Oral Maxillofac Surg. 2019 Oct;77(10):2018.e1-2018.e4. doi: 10.1016/j.joms.2019.06.013. Epub 2019 Jun 24.
A 72-year-old male cardiac transplant patient presented after sustaining facial and extremity trauma caused by a pit bull dog attack. The case was further complicated by the duration of the surgery, bleeding, infection risk, intraoperative hypothermia, immunosuppression, and the risk of sepsis. His anesthetic management required careful coordination with his transplant team. We also sought the expertise of the in-house pharmacist to obtain the appropriate administration strategies for the patient's immunosuppressant agents. As the number of transplant patients increases, oral and maxillofacial surgeons must remain cognizant of the challenges and strategies associated with treating those undergoing graft-preserving immunosuppression. We have presented a more complex case of a cardiac transplant patient requiring extensive facial soft tissue reconstruction. The experience achieved in the management of a complex cardiac patient will no doubt provide guidance in the management of elective surgical procedures in other patients with simpler transplant histories.
一名72岁的男性心脏移植患者在遭到斗牛犬袭击导致面部和四肢创伤后前来就诊。手术时间、出血、感染风险、术中低温、免疫抑制以及败血症风险使该病例更加复杂。他的麻醉管理需要与移植团队仔细协调。我们还寻求了医院内部药剂师的专业意见，以获取患者免疫抑制剂的适当给药策略。随着移植患者数量的增加，口腔颌面外科医生必须始终认识到与治疗接受免疫抑制以保留移植物的患者相关的挑战和策略。我们展示了一个需要广泛面部软组织重建的心脏移植患者的更复杂病例。在管理复杂心脏患者方面获得的经验无疑将为管理移植病史较简单的其他患者的择期手术提供指导。
