General Anaesthesia and Emergency Surgery in Heart Transplant Recipient

Abstract

The number of patients who undergo heart transplant is increasing. Due to surgical emergencies, many of those may require general anesthesia in hospitals where subspecialized anesthetists may not be available. We present a case of a male patient who had heart transplant and required general anesthesia for emergency appendicectomy. Physiology of the heart after transplant, preoperative considerations, and postoperative monitoring has been discussed in our report.

Post-cardiac transplant recipient: Implications for anaesthesia

“…There is a loss of sympathetic response to laryngoscopy and intubation. [ 35 ] Laryngeal mask airway is not contraindicated. The denervated heart has a blunted HR response to inadequate anaesthetic depth or analgesia.…”

“…Because atropine has no effect on a transplanted heart, isoprenaline and epinephrine should be readily available to manage bradycardia and hypotensive emergencies. [ 35 ] Table 4 summarises the haemodynamic response of some commonly used drugs for resuscitation.…”

Anesthetic considerations for non-cardiac surgeries in orthotopic heart transplant recipients

“…Mycophenolate mofetil may result in anemia, leukopenia, and thrombocytopenia. [ 8 ] We ensured that immunosuppressants were continued throughout his admission to reduce the risk of organ rejection. Transplant patients are considered at risk of infection because of immunosuppression.…”

Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery

“…The use of a laryngeal mask is acceptable (within its indications) [43]. Keep in mind that laryngoscopy and tracheal intubation may not produce a sympathetic response secondary to the loss of cardiac baroreceptor reflexes in heart transplanted patients [44]. Avoid hyperventilation in patients taking cyclosporine and tacrolimus because of a decrease in seizure threshold with these two drugs.…”

“…that of normal heart because intact sympathetic nerves are required for the normal uptake and metabolism of catecholamines. The receptor density, however, remains unchanged, and the transplanted heart can respond to direct-acting drugs (adrenaline and noradrenaline) [67]. Isoprenaline and dobutamine have similar effects in both transplanted and normal heart.…”