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Regional Anesthesiologists Play Crucial Role in Duke’s First Hand Transplant By Stacey Hilton

Nearly 50 years after a meat-grinding accident, a Texas man received a new left hand during a 12-hour surgery at Duke University Hospital that made medical history. On May 27, a team of five anesthesiologists and 17 surgeons performed the first hand transplant in North Carolina. “It was a good day,” says Dr. Joshua Dooley, the lead anesthesiologist on the case who spent nearly six months working with the surgeons to develop an optimal anesthesia protocol for the patient. “Our team of anesthesiologists played a critical role in this transplant. It was our job to keep the patient asleep under general anesthesia, keep him alive during the surgery, give him the proper blood products, and ensure that he had optimal pain control when he woke up.”

The anesthetic team also controlled the patient’s vital signs for those 12 hours, giving surgeons the best possible opera­tive field during the microsurgery, an intri­cate process of connecting bones, blood vessels, muscles, nerves, tendons and skin. A crucial component of this transplant was Dr. Dooley’s ability to perform a regional nerve block on the patient using a peripheral nerve catheter, a specialized procedure used by Duke Anesthesiology’s Orthopaedics, Plastics and Regional Anesthesiology Division that is only available at a small percentage of hospitals across the country. He used ultrasound to place a nerve catheter near the nerves that are responsible for pain and movement of the arm. Local anesthetic was then deposited around those nerves which increased blood flow and provided proper pain control that would last for days after the surgery to avoid heavy reliance on narcotics. Dr. Linda Cendales changing dressings on Rene Chavez’s new hand after his “It was extremely important to highly complex, 12-hour surgery was performed on May 27. He is one of less get the placement of that nerve than 90 people worldwide to undergo a hand transplant. 4

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DUKE ANESTHESIOLOGY

catheter in ex­actly the right spot without injuring any large blood vessels or his lung, which could have possibly canceled the case,” says Dr. Dooley. Given the high complexity of this surgery that’s only offered at nine other hospitals in the nation, Dr. Dooley knew it was crucial to choose anesthesiologists who possessed the skill set necessary for this life-altering procedure to care for the patient. Two of those anesthesiologists are Dr. Michael Bullock and Dr. Michael Shaughnessy, both of whom received their fellowship training in regional/ ambulatory anesthesiology at Duke. “Even though the public may see it as ‘just a hand,’ it’s actually a pretty vital structure that has the potential for catastrophe if not handled correctly,” says Dr. Bullock. “From our perspective, we knew everything had to go perfectly to ensure success,” adds Dr. Shaughnessy who took the handover report from Dr. Dooley early that Friday morning and managed the patient’s anesthetic for the next eight hours during retrieval of the donor limb and the early phase of connecting the blood vessels and the tissues. “That was when we saw the most significant amount of bleeding,” says Dr. Shaughnessy. “The biggest challenge was managing the blood loss. We had to be careful not to over transfuse or under transfuse.” “We know with patients like this, there will be a fair amount of blood loss that

Photos Courtesy of Duke Health

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2016 BluePrint  
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