Anesthetic management in lung transplantation: Our single-center experience

Abstract

Background: In this study, we aimed to discuss our anesthesia management strategies, experiences, and outcomes in patients undergoing lung transplantation. Methods: Between December 2016 and December 2018, a total of 53 patients (43 males, 10 females; mean age: 46.1±13 years; range, 14 to 64 years) undergoing lung transplantation in our center were included. The anesthesia technique, patients" characteristics, and perioperative clinical and follow-up data were recorded. The stage of lung disease was assessed using the New York Heart Association functional classification. Results: Two patients underwent single lung transplantation, while 51 patients underwent double lung transplantation. Idiopathic pulmonary fibrosis was the most common indication in 41.5% of the patients. All patients had end-stage lung disease (Class IV) and 79% were oxygen-dependent. The extracorporeal membrane oxygenation support was given to 32 patients. Conclusion: The anesthetic management of lung transplantation is challenging, either due to the deterioration of the recipient"s physical performance and the complexity of the surgical techniques used. In general, a kind of mechanical support may be needed and extracorporeal membrane oxygenation is the first choice in the majority of patients. A close communication should be maintained between the surgeons, perfusion technicians, and anesthesiologists to ensure an optimal multidisciplinary approach and to achieve successful outcomes.

Intraoperative Circulatory Support in Lung Transplantation: Current Trend and Its Evidence

“…Using various monitoring methods, it is important to avoid both hyper- and hypo-volaemia [ 55 ]. The measurement of pulmonary arterial pressures and CO as well as TOE continues to be of particular importance [ 4 , 44 ]. There is a lack of robust data to definitively recommend specific catecholamine therapies.…”

“…In the case of poor oxygenation through the diseased lung or also the newly implanted lung and preserved pulsatility, there is the possibility that the endogenous blood flow with low oxygen content and the blood flow of VA ECMO with high oxygen content meet at the level of the aortic arch. Thus, it is possible, for example, that the oxygen content in the right carotid artery is too low, while there is no disturbance on the left side [ 43 , 44 , 45 ]. This phenomenon of the ECMO watershed and the possibly associated oxygen deficiency of the brain during the use of VA ECMO is attempted to be countered by monitoring the blood gases as close to the heart as possible.…”