Anesthesia for Heart or Single or Double Lung Transplantation in the Adult Patient

Abstract

Providing an anesthetic for patients undergoing heart or a single or double lung transplantation may represent a challenge even t o the most experienced anesthesiologist. Patients with end-stage cardiac dysfunction have an impaired response t o p-agonist due t o receptor downregulation. These patient will have isolated left ventricular dysfunction secondary t o ischemic heart disease or present with biventricular failure with or without significant pulmonary hypertension. Increasingly, more patients have undergone prior major cardiac procedures and are at risk for significant perioperative bleeding. Patients undergoing single or double lung are particularly challenging because most of these procedures are performed without the aid of cardiopulmonary bypass. The anesthesiologist must be proficient at the management of one-lung ventilation techniques and have a rational physiologic approach t o the management of intraoperative hypoxemia and auto-PEEP. (J Card Surg 2000; 15: 767-1 74)

Anesthetic management of a patient with a double inferior vena cava and pulmonary alveolar proteinosis who underwent bilateral living-donor lobar lung transplantation

“…Surgical exposure of the right femoral artery and vein was performed after anesthetic induction for immediate and assured vascular access to establish ECC in case of cardiopulmonary collapse before thoracotomy incision [9]. Cardiopulmonary function was preserved until CPB establishment for lung resection in the present patient.…”

Anesthesia for Lung Transplantation

“…Continuous positive airway pressure to the operative lung can be effective in reducing intrapulmonary shunt by allowing apneic oxygenation. 13 The application of PEEP to the lung being ventilated may also reduce shunt, but vigilance for the development of dynamic hyperinflation needs to be maintained.…”