Obesity & Anesthesia

It is important for anesthesiologists to have a good working knowledge of the care of patients who are brain dead for organ donation. The organ harvest procedure includes care not only by surgical procurement teams and an organ recovery organization, but also by anesthesiologists. While brainstem function is absent in brain dead patients, the spinal cord as well as somatic and visceral reflexes are intact. Central nervous system structures essential to the definition of brain death do not include the spinal cord, although perfusion to the spinal cord may also be affected. Spontaneous and reflexive movements are often present in brain dead patients, and these movements may seem bizarre and purposeful, occurring at times such as during apnea testing for brain death criteria, patient transport and during organ harvest procedures. Thus, during organ harvest procedures, muscle relaxants are necessary to prevent motor activity mediated by spinal reflexes to noxious stimuli. Often vasodilators and sometimes vasoconstrictors are necessary to modulate blood pressure and heart rate. Sedation, anesthesia and analgesia are theoretically not necessary as patients are unconscious and brain dead.