Anaesthesia for noncardiac surgery in the heart transplant recipient

Abstract

Understanding how to administer fluids adequately to a transplant patient; how to use direct vasoactive agents; how to manage the infectious risk; and the need to be aware of the multiple side effects of immunosuppressive regimens are essential to recognize, prevent or treat possible perioperative complications.

Anesthesia for Cardiac Surgery in Neonates

“…Regardless of the time interval from transplantation, when caring for these neonates, the following considerations are suggested: (1) have drugs with chronotropic properties immediately available, (2) use agents with a direct action on the myocardium and vasculature, and (3) prepare emergent cardiac pacing modalities. Several additional issues are important in the anesthetic care of the transplanted patient [ 345 ]. Immunosuppressant agents, which may need to be given during the perioperative period, may have secondary effects on various organ systems (particularly the heart, liver, and kidney) and interact with anesthetic agents (muscle relaxants).…”

Comment organiser la prise en charge anesthésique d’un patient transplanté en chirurgie générale ?

“…Pour cette raison, lorsque c'est possible, l'anesthésie générale sera préférée à la rachianesthésie. Le monitorage hémodynamique, en particulier pour les interventions les plus lourdes, a tout son intérêt, en particulier si celui-ci est non invasif [16].…”

“…Il est donc important de maintenir une bonne pression de perfusion coronaire au cours de l'anesthésie [16,17].…”

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

“…Efferent denervation ablates the resting parasympathetic tone responsible for maintaining baseline heart rate. Because of this, transplanted patients generally have an increased baseline heart rate of 90 to 100 beats per minute [38]. The loss of direct sympathetic innervation means that the cardiac response to physiologic stressors (exercise, hypovolemia, vasodilatation, pain, light anesthesia) is mediated by circulating catecholamines and, as a result, tends to occur much less quickly.…”

“…If a portion of the patient's native right atrium was retained during surgery, the ECG may demonstrate 2 P waves: 1 from the native atria (not conducted beyond the suture line) and another from the donor SA node (conducted normally via the AV node) [38]. Ventricular ectopy is common in the first several weeks after transplant, but usually diminishes.…”