Anesthesia for uterine transplant surgery

Uterine transplantation is an emerging procedure that has been proposed as a solution to women with absolute uterine factor infertility (AUFI). Uterine transplantation is currently considered an experimental procedure and is most appropriately performed inside IRB-approved research protocols. General anesthesia with endotracheal intubation utilizing a balanced anesthetic approach is the standard of care for uterine transplantation. Invasive blood pressure monitoring and infusion of vasoactive medications are often utilized to maintain a mean arterial pressure >65 mmHg or within 20% of baseline and during creation of the vascular anastomoses. Intraoperatively, the anesthesia team should be prepared for significant blood loss with adequate intravenous access, blood availability and autologous cell salvage equipment when available. While anesthetic complications have not been reported, recipients of uterus transplantation surgery are at risk for numerous postoperative complications including hemoperitoneum, venous or arterial graft thrombosis and infection resulting in graft necrosis requiring hysterectomy. This chapter outlines the unique aspects in the perioperative management of the recipients of uterine transplantation surgery including criteria for selection, preoperative testing related to anesthesia, intraoperative anesthetic management and events and postoperative challenges.