Anaesthetic management of bilateral hand transplantation: A case series

Background: Bilateral hand transplantation is a rare surgery being considered for patients with bilateral upper limb loss. The procedure, though not lifesaving, is a life-altering procedure with inherent risks. Aims and Objectives: The anaesthetic management of these patients is technically challenging, with huge fluid shifts, blood loss, haemodynamic instability and hypothermia. We aimed to find out the major perioperative concerns and their management strategies during bilateral hand transplantation surgery by retrospectively analysing the anaesthetic management of six such cases. Materials and Methods: A retrospective study of the anaesthetic management of six patients who underwent bilateral hand transplants in our institute, and their post-operative outcomes is described. Results: All cases were performed under general anaesthesia with supplemental brachial plexus block. The major intraoperative concerns were immunosuppression, massive blood loss and fluid replacement, haemodynamic instability, reperfusion injury and hypothermia. Vasopressors were used in four out of the six patients with no major effect on the graft survival outcome. These patients have been followed up for a time period varying from 6 months to 3 years and have been successfully rehabilitated back to normal life. Conclusion: Bilateral hand transplants can be safely performed under general anaesthesia with supplemental brachial plexus block. The anaesthetic management of these patients is challenging and requires a structured approach with good facilities for perioperative management.