An Update on Postoperative Analgesia Following Lung Transplantation

Gelzinis, Theresa A.

doi:10.1053/j.jvca.2018.05.014

Cited by 7 publications

(6 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thoracic epidural anesthesia in surgical patients allows for adequate postoperative pain control, increases deep breathing, and expulsion of secretions; and decreases myocardial ischemia, mechanical ventilation, pneumonia, ICU duration, and graft failure in transplant patients. 5 Potential complications include epidural hematoma (theoretically an increased risk in with systemic heparinization) and epidural migration. In a review of >4000 patients with epidural catheterizations who required systemic heparinization, there was no episode of hematoma formation, concluding a risk of epidural hematoma 1:1500 to 1:150,000.…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report

Hussey¹,

Sowell

Hussey³

et al. 2023

A&A Practice

View full text Add to dashboard Cite

Differential diagnosis of the underlying cause of new-onset total body paralysis can be challenging and unsatisfying. In akinetic mutism, a rare side effect of tacrolimus, patients become apathetic, mute, and lose voluntary muscle movement. Epidural subarachnoid migration can present with similar symptoms. Delayed emergence/paralysis after anesthesia can include the common culprits of residual operative medications, stroke, as well as tacrolimus-induced akinetic mutism and thoracic epidural migration. We present a case of new-onset total body paralysis, presenting on postoperative day 1 following a double-lung transplant in a patient started on tacrolimus with a thoracic epidural catheter in place.

show abstract

Section: Discussionmentioning

confidence: 99%

Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report

Hussey¹,

Sowell

Hussey³

et al. 2023

A&A Practice

View full text Add to dashboard Cite

show abstract

“…Furthermore, a recent review highlights the physiologic benefits of good perioperative pain management in this lung transplant population, including improvements in graft function, extubation times, patient satisfaction, and reduced intensive care unit length of stay during hospitalization. 28 However, many of these are extremely small studies that highlight individual and institutional variability in which neuraxial techniques, regional techniques, and non-opioid adjuncts are chosen and how they are implemented. Perioperative strategies have included thoracic epidural catheters as a gold standard, although the timing of epidural placement, 29 variability in local anesthetic solution are used, and choice of adjuncts makes comparing outcomes difficult.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Chronic Pain Outcomes After Lung Transplantation

Klinger

Cunniff

Mamoun

et al. 2019

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

Chronic pain after lung transplantation is a significant concern, in particular given the heterogeneity of the patient population and the challenges of achieving adequate pain control amid concerns related to complex immunosuppressant regimens and the possibility of respiratory depression. We undertook a patient-reported outcomes (PRO) survey administered via our electronic health care portal to examine the postoperative incisional pain prevalence in a cohort of lung transplant recipients at a single, high-volume center where bilateral thoracosternotomy is the preferred surgical approach. The Patient Reported Outcomes Measurement Information System (PROMIS) Global Health and Pain Intensity short forms were sent to a total of 173 lung transplant recipients who were more than 2 months postsurgery at the time of the study. A total of 64 patients responded to both PROMIS surveys (response rate 38%). In the cohort of survey respondents, we observed a chronic pain incidence of 58% after lung transplantation (median pain score 1/10) and an overall good quality of life score (median score 4/5); however, only 9.4% reported moderate-severe pain (pain score ≥5/10). Survey nonrespondents had higher rates of pretransplant opioid and psychiatric medication use compared with respondents. In this study, we demonstrated the feasibility of using an electronic PRO survey for assessing postoperative pain outcomes after lung transplantation. However, measuring pain outcomes using this type of tool highlights issues of response rate and potential selection bias. Larger studies are needed to adequately assess the risk and predictors of chronic pain after lung transplantation and its impact on quality of life.

show abstract

“…Overall, data regarding the impact of analgesic approach on lung transplantation outcomes are limited, however, T E A h a s b e e n s h o w n t o d e c r e a s e p o s t o p e r a t i v e mechanical ventilation time in these patients (92). Other pain management strategies reported include the use of paravertebral catheters, serratus anterior plane block, and erector spinae block (52,93). Larger studies are necessary to delineate the optimal pain management approach in this patient population, and should include direct comparisons of specific regional anesthetic techniques to each other.…”

Section: Pain Management Strategies In Lung Transplantationmentioning

confidence: 99%

Anesthetic considerations in lung transplantation: past, present and future

Murray¹,

Boisen²,

Fritz³

et al. 2021

J Thorac Dis

View full text Add to dashboard Cite

Lung transplantation is a very complex surgical procedure with many implications for the anesthetic care of these patients. Comprehensive preoperative evaluation is an important component of the transplant evaluation as it informs many of the decisions made perioperatively to manage these complex patients effectively and appropriately. These decisions may involve pre-emptive actions like pre-habilitation and nutrition optimization of these patients before they arrive for their transplant procedure. Appropriate airway and ventilation management of these patients needs to be performed in a manner that provides an optimal operating conditions and protection from ventilatory injury of these fragile post-transplant lungs.Pain management can be challenging and should be managed in a multi-modal fashion with or without the use of an epidural catheter while recognizing the risk of neuraxial technique in patients who will possibly be systemically anticoagulated. Complex monitoring is required for these patients involving both invasive and non-invasive including the use of transesophageal echocardiography (TEE) and continuous cardiac output monitoring. Management of the patient's hemodynamics can be challenging and involves managing the systemic and pulmonary vascular systems. Some patients may require extra-corporeal lung support as a planned part of the procedure or as a rescue technique and centers need to be proficient in instituting and managing this sophisticated method of hemodynamic support.

show abstract

An Update on Postoperative Analgesia Following Lung Transplantation

Cited by 7 publications

References 20 publications

Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report

Tacrolimus-Induced Akinetic Mutism or Epidural Catheter Migration: A Case Report

Patient-Reported Chronic Pain Outcomes After Lung Transplantation

Anesthetic considerations in lung transplantation: past, present and future

Contact Info

Product

Resources

About