Anesthesia for bilateral lung transplantation without cardiopulmonary bypass: Initial experience and review of intraoperative problems

Raffin, L.; Michel-Cherqui, Mireille; Sperandio, M.; Bonnette, P.; Bisson, A; Loirat, Philippe; Fischler, Marc

doi:10.1016/1053-0770(92)90005-r

Cited by 26 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In these cases, ECLS will offload the demands of the right ventricle. Flows should be maintained at 2 to 4 L/min, cardiac output should remain pulsatile, and the systolic PAP should be <30 mmHg [5].…”

Section: Patient Selection For Eclsmentioning

confidence: 99%

“…Patients who are unable to tolerate clamping of the pulmonary artery or single-lung ventilation will likely require ECLS. Parameters that guide the decision to initiate ECLS include persistent hypoxemia due to an intractable shunt with an SpO 2 of <90%, despite clamping the ipsilateral pulmonary artery; respiratory acidosis with a pH <7.20, in spite of optimal settings for respiratory support; and hemodynamic issues with increases in mean PAP and decreases in cardiac output with a mixed venous O 2 of <55%, despite proper use of inotropic or vasoactive agents [5]. A TEE is also useful for evaluating right ventricular function, dilation, and early signs that ECLS will be necessary with a test clamping of the pulmonary artery [3].…”

Section: Patient Selection For Eclsmentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal life support during lung transplantation

Coster

Loor

2021

Indian J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

Lung transplantation surgeries are performed without extracorporeal life support (ECLS) by using an off-pump technique; however, in cases of hypoxemia or hemodynamic instability, intraoperative ECLS may be required. Cardiopulmonary bypass (CPB) has traditionally been the standard practice for ECLS but has been associated with an increased risk of bleeding in the perioperative period, increased transfusion requirements, prolonged postoperative intubation, and possibly primary graft dysfunction. More recently, because of the flexibility of using extracorporeal membrane oxygenation (ECMO) in bridging to transplantation and during postoperative recovery, its use has increased. CPB and ECMO each has advantages and disadvantages; however, because comparisons of CPB and ECMO have been limited to small retrospective observational and single-institution studies, more research is required to determine the superiority of one modality. In this review, we critically examine the pros and cons of performing lung transplantation surgery off-pump or by using the ECLS modalities of ECMO and CPB support during lung transplantation surgery.

show abstract

Section: Patient Selection For Eclsmentioning

confidence: 99%

Section: Patient Selection For Eclsmentioning

confidence: 99%

Extracorporeal life support during lung transplantation

Coster

Loor

2021

Indian J Thorac Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…Many centers use thoracic epidural analgesia for lung transplant cases. 2,[5][6][7][8][9] Immunosuppressive induction may be started preoperatively, with the patient receiving the first dose of immunosuppressive agents orally. 1 Preoperative sedatives should be used sparingly, because benzodiazepines and narcotics may exacerbate preexisting hypercarbia and hypoxia, particularly in the patient with COPD.…”

Section: Preanesthetic Evaluation and Preparationmentioning

confidence: 99%

Anesthesia for Lung Transplantation

Miranda

Zink

McSweeney

2005

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

Lung transplantation is the only therapeutic option for more than 3,000 individuals in the United States with end-stage lung disease. Innovations in anesthetic and surgical techniques have expanded the indications for lung transplantation. Presently, the major limiting factor in the number of lung transplantations that are performed is the availability of suitable donor organs. Lung transplantation includes a number of surgical procedures, including single-lung, double-lung, bilateral-sequential-single-lung, heart-lung, and lobar transplantation. Patients undergoing lung transplantation present a variety of challenges to the anesthesia team. Critical periods include induction of anesthesia, initiation of positive pressure ventilation, establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Pharmacologic advances have been an important factor in the continued development and success of lung transplantation. Newer immunosuppressive agents have improved the prevention and management of post-transplant rejection. Selective pulmonary vasodilators that are administered via inhalation affect the anesthetic management during the surgical procedure. Technologic advances in monitoring have also been valuable in lung transplantation. Transesophageal echocardiography is commonly used to evaluate intraoperative ventricular function. Continuous cardiac output, mixed venous oxygen saturation, continuous arterial blood gas monitoring, and the bispectral index have also been used to monitor the patient during lung transplantation. Anesthetic management of lung transplantation requires a thorough understanding of end-stage lung disease and pharmacologic and technical considerations that may not be applicable in any other part of anesthetic practice.

show abstract

“…Patients undergoing lung transplantation usually have some form of end-stage lung disease and can be conveniently divided into four groups 17: (1) suppurative lung disease, (2) emphysema, (3) restrictive lung disease (pulmonary fibrosis), and (4) pulmonary hypertension, with or without congenital heart disease. Experience from the author's institution, in which 47 HLTx, 88 SLTx, and 82 BSLTx have been performed since 1989, is typical of those with a high caseload (Table 1).…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Aspects of Anesthesia for Lung Transplantation

Myles

1998

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

Anesthesia for lung transplantation is both a demanding and rewarding experience. Success requires teamwork, experience, knowledge of cardiorespiratory pathophysiology and its anesthetic implications, appropriate use of noninvasive and invasive monitoring, and the ability to respond quickly and effectively to lifethreatening perioperative events. Specific issues include management of a patient with end-stage lung and heart disease, lung isolation and one-lung ventilation, perioperative respiratory failure, pulmonary hypertension, and acute right ventricular failure. Recent advances include greater understanding of dynamic hyperinflation ("gas-trapping") during mechanical ventilation, perioperative use of inhaled nitric oxide and treatment of acute right ventricular failure. Successful anesthetic management leads to greater hemodynamic stability, improvement in gas exchange and a reduction in need for cardiopulmonary bypass, all of which should lead to improved patient outcome.Copyright@ 1998 by IIV. B. Saunders Company.Anesthesia for lung transplantation is one of the most complicated and demanding procedures that anesthesiologists are confronted with in their practice. Issues that arise include management of a patient with end-stage lung and heart disease, lung isolation and one-lung ventilation (OLV), perioperative respiratory failure, pulmonary hypertension and right ventricular (RV) failure, pathophysiology of cardiopulmonary bypass (CPB), coagulopathy and multiple blood product transfusion, maintenance of other vital organ function (especially brain and kidneys), and postoperative pain management.1&dquo;21 Critical incidents during the procedure are common and often life-threateningB-11 ,14,19,20; they demand rapid assessment and intervention. This can be compromised by anesthesiologist fatigue because most lung transplantation procedures take 6 to 10 hours and usually occur at night, often after a busy cardiothoracic operating scheduse.1,2,4 Successful management demands both knowledge and experience, and this is best optimized by concentrating clinical exposure to lung transplantation among a small number of dedicated anesthesiologists at any one institution. Although this increases individual work load, it does enhance expertise and consistency of practice. Work schedules the day after transplantation can be reorganized, and this is most efficiently achieved with a cohesive cardiothoracic anesthetic team. As with other types of specialized surgery, 22 outcome after lung transplantation may be affected by caseload, with larger units having more favorable results.5 Accumulating experience within an institution is also associated with improved outcome'5 ; at the author's institution, a 50% reduction from 20% to 10% in early (<90 days) postoperative mortality rate over the first 7 years of the program (G. Snell, personal communication, May 20, 1997) has been observed.Ideally, clinical practice should be evidencebased, guided by clinical trials showing superiority of one treatment over another.23,24 However, i...

show abstract

Anesthesia for bilateral lung transplantation without cardiopulmonary bypass: Initial experience and review of intraoperative problems

Cited by 26 publications

References 34 publications

Extracorporeal life support during lung transplantation

Extracorporeal life support during lung transplantation

Anesthesia for Lung Transplantation

Aspects of Anesthesia for Lung Transplantation

Contact Info

Product

Resources

About