Anesthesia for Patients with Transplanted Lungs and Heart and Lungs

Boscoe, M. J.

doi:10.1097/00004311-199503320-00004

Cited by 16 publications

(40 citation statements)

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“…Patients with congenital heart disease undergoing general surgical procedures are recognized to have a significant rate of perioperative complications, and we also suspect that spinal surgery in a heart transplant patient might be even more problematic [6,7,8,16].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, there is a lag period in the haemodynamic response because the increased cardiac output is secondary to humoral reflexes (release of catecholamines) rather than to neural reflexes [14]. Heart transplant recipients are thus said to be "pre-load dependant" and require continuous echocardiographic monitoring of cardiac function perioperatively [6,7,8,16]. In patients with congenital heart disease, the best predictor of perioperative complications is an American Society of Anesthesiologists (ASA) score of 3 or higher [8].…”

Section: Discussionmentioning

confidence: 99%

“…However, it will respond to drugs acting directly on the heart or via humoral reflexes such as isoproterenol, ephedrine or dopamine [6,7,16].…”

Section: Discussionmentioning

confidence: 99%

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Corrective surgery for idiopathic scoliosis after heart transplantation

et al. 2001

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Cardiac transplant surgery is being performed with increasing frequency as a treatment for end-stage heart disease. In addition to the well-known post-surgical problems of rejection and infection, these patients may present at a future date with other medical problems which require surgical treatment, including orthopaedic pathology. Severe idiopathic scoliosis has been described in association with congenital heart disease, and its surgical treatment poses considerable risks because of heart disease. Spinal fusion in heart transplant recipients involves similar risks due to the particular physiology and pharmacological reactions of the denervated heart. Several cases of cholecystectomy performed in heart transplant recipients have been described, but to our knowledge no orthopaedic procedures have been reported in such patients. We report on a 15-year-old patient who underwent successful corrective surgery for idiopathic scoliosis 14 months after heart transplant

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Corrective surgery for idiopathic scoliosis after heart transplantation

et al. 2001

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“…With regard to fluid balance, oedema and heart failure management, diuretics may be part of the anti-hypertensive regimen, but the hydration status must be considered in all LTRs since overly aggressive diuretic treatment may enhance renal failure due to a pre-renal component, more so than in non-transplanted patients [72]. We tend to encourage our patients to drink sufficient liquids on a regular basis (depending on age and co-morbidity, the amount is individually defined between 2 and 4 litres/day) and adjust diuretics and anti-hypertensive and heart failure drugs to the steady state obtained in a constant hydration status.…”

Section: Cardiovascular and Fluid Balance Emergenciesmentioning

confidence: 99%

“…The most frequent complications we observe are peri-operative deterioration due to a combination of fluid imbalance/hypertensive blood pressure measurements and attempts to correct these with subsequent worsening renal function and sometimes acute heart failure. This is likely related to the disruption of pulmonary lymphatics and bronchial circulation leading to an increased risk of pulmonary oedema [72,73]. Therefore, fluid management should be conservative in the peri-operative setting, and diuretics should be prescribed if necessary [70].…”

Section: Surgery and Other Invasive Proceduresmentioning

confidence: 99%

Practical Approach to Emergencies in Lung Transplant Recipients: How We Do It

et al. 2012

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Lung transplant recipients (LTRs) are prone to medical complications and emergencies due to the transplanted organ being in constant direct contact with the environment and the need for life-long profound immunosuppression (IS). As a result of these specific circumstances, the medical and surgical management of LTRs frequently differs from usual standard care. Therefore, we outline here some of the principles we take into account when dealing with the most frequent medical emergencies encountered in our lung transplant cohort in Zurich. The main topics dealt with are: diagnostics and treatment of infections, gastrointestinal emergencies, IS and other medication issues as well as work-up of unclear inflammatory signs and peri-operative precautions in LTRs. Early post-operative transplant complications, rare medical emergencies and surgical problems are not covered. Our report is intended to help internists and pulmonologists new to the field to obtain a better understanding of the peculiarities of LTRs and their management.

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