A non‐thoracic operation for a patient with single lung transplantation

Abstract

The number of lung transplants performed annually is increasing. It is becoming more likely that these patients will present post transplantation to anesthesiologists who have little experience in dealing with the physiological, pharmacological, medical and surgical problems that these patients present. This article discusses the management of a patient presenting for surgery after lung transplantation.

The Anesthetic Management of Adult Patients with Organ Transplants Undergoing Nontransplant Surgery

“…This, of course, places the recipient at risk for both aspiration and infection. In the normal lung, autonomic innervation is responsible for regulating airway tone, however, there seems to be no clinically significant change in bronchomotor tone after transplantation nor is there an increase in the incidence of airway hyperreactivity [46]. Bronchodilators continue to be effective although some investigations suggest their effect is slightly decreased.…”

Anaesthesia for patients with a transplanted organ

“…The drugs can also be administered via a nasogastric tube, if the use of suction can be avoided ( 73). It is suggested that the transplantation unit should recommend doses and routes of administration ( 118). Cyclosporine dose conversion for parenteral use may be difficult because of the individually variable intestinal absorption, and the parenteral solution is incompatible with many plastic materials ( 80).…”

“…High oxygen content may also aggravate pulmonary manifestations in Goodpasture’s syndrome ( 34). Bronchoconstriction is possible in transplanted lungs, may be related to rejection, and may not respond to normal bronchodilator therapy ( 118).…”

“…It is advised to extubate these patients with the worse lung dependent to protect the better lung from aspiration. Positioning of the patient and early postoperative physiotherapy should aid in lung drainage ( 118).…”

“…The signs of rejection are mostly similar to the signs of infection. However, increasing fatigue, dyspnoea, decreased voltage in the electrocardiogram, and cardiac arrhythmias in heart transplant patients (12,15), dyspnoea, fatigue, pyrexia, leukocytosis, desaturation and over 10% decrease in forced vital capacity and forced expiratory volume in lung transplant patients (5,12,16,73,118), increasing serum creatinine, decreasing urine output, proteinuria and reduced graft function in kidney transplant patients (25,85), and malaise, fever and increasing serum bilirubin in liver transplant patients (119) should alert for the possibility of rejection. In bone marrow transplant patients, maculopapular skin rash, liver dysfunction with increased bilirubin, alkaline phosphatase and transaminases, abdominal pain and diarrhoea appear during acute graft-versushost rejection.…”