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Prabhu M, Valchanov K. Pre-anaesthetic evaluation of the patient with end-stage lung disease. Best Pract Res Clin Anaesthesiol 2017; 31:249-260. [PMID: 29110797 DOI: 10.1016/j.bpa.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/10/2017] [Indexed: 11/29/2022]
Abstract
Lung transplantation is a viable alternative for end-stage lung diseases, which offers good quality of life and survival outcomes for recipients. The aims of pre-assessment for potential lung transplant recipients are to assess fitness for surgery, optimise co-morbidities, commence interventions or investigations, weigh risk-benefit ratio, plan appropriate analgesia and obtain informed consent. The assessment information is gathered from the medical record, patient interview, physical examination and pre-operative tests. A comprehensive workup includes cardiopulmonary evaluation, haematological, biochemical, microbiological and immunological investigations. Most of the evidence regarding lung transplantation is gleaned from retrospective data from single, multi-centre or multinational registries. The lack of good quality evidence means that the guidelines are based on expert consensus.
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Affiliation(s)
- Mahesh Prabhu
- Cardiothoracic Anaesthesia and Intensive Care, Freeman Hospital, Freeman Road, High Heaton, Newcastle upon Tyne NE7 7DN, UK.
| | - Kamen Valchanov
- Anaesthesia and Intensive Care, Papworth Hospital, Cambridge CB23 3RE, UK.
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Abstract
Lung transplantation is the only therapeutic option for more than 3,000 individuals in the United States with end-stage lung disease. Innovations in anesthetic and surgical techniques have expanded the indications for lung transplantation. Presently, the major limiting factor in the number of lung transplantations that are performed is the availability of suitable donor organs. Lung transplantation includes a number of surgical procedures, including single-lung, double-lung, bilateral-sequential-single-lung, heart-lung, and lobar transplantation. Patients undergoing lung transplantation present a variety of challenges to the anesthesia team. Critical periods include induction of anesthesia, initiation of positive pressure ventilation, establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Pharmacologic advances have been an important factor in the continued development and success of lung transplantation. Newer immunosuppressive agents have improved the prevention and management of post-transplant rejection. Selective pulmonary vasodilators that are administered via inhalation affect the anesthetic management during the surgical procedure. Technologic advances in monitoring have also been valuable in lung transplantation. Transesophageal echocardiography is commonly used to evaluate intraoperative ventricular function. Continuous cardiac output, mixed venous oxygen saturation, continuous arterial blood gas monitoring, and the bispectral index have also been used to monitor the patient during lung transplantation. Anesthetic management of lung transplantation requires a thorough understanding of end-stage lung disease and pharmacologic and technical considerations that may not be applicable in any other part of anesthetic practice.
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Affiliation(s)
- Allen Miranda
- Department of Anesthesiology, University of Wisconsin Hospitals and Clinics, Madison, WI
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Abstract
Over the past few decades, major surgical procedures involving the thorax have become commonplace at most larger medical facilities. Advances in perioperative care have allowed surgeons to perform increasingly complex procedures. These procedures are being performed on more seriously ill patients who are at increased risk for significant complications. Recent advances should help the anesthesiologist avoid some of the pitfalls in managing these complex patients. Preoperative assessment aids in the identification of patients at highest risk for intraoperative and postoperative events. Particular attention is given to myasthenia gravis, as thymectomy is among the most common surgical procedures that are performed in these patients. Aggressive pain control techniques, including neuraxial opioids and patient-controlled analgesia, where appropriate, not only improve patient comfort but can improve postoperative pulmonary function. Advances in techniques for providing one-lung ventilation allow the anesthesiologist more options to individualize management for each clinical scenario. Careful fluid management may help to minimize the risk of postoperative pulmonary complications. A basic understanding of video-assisted thoracic surgery should help the anesthesiologist provide optimal surgical conditions and perioperative care. Recent advances demand a greater role for the anesthesiologist if the best outcomes are to be achieved in patients undergoing thoracic procedures.
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Barnes L, Reed RM, Parekh KR, Bhama JK, Pena T, Rajagopal S, Schmidt GA, Klesney-Tait JA, Eberlein M. MECHANICAL VENTILATION FOR THE LUNG TRANSPLANT RECIPIENT. CURRENT PULMONOLOGY REPORTS 2015; 4:88-96. [PMID: 26495241 DOI: 10.1007/s13665-015-0114-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Mechanical ventilation (MV) is an important aspect in the intraoperative and early postoperative management of lung transplant (LTx)-recipients. There are no randomized-controlled trials of LTx-recipient MV strategies; however there are LTx center experiences and international survey studies reported. The main early complication of LTx is primary graft dysfunction (PGD), which is similar to the adult respiratory distress syndrome (ARDS). We aim to summarize information pertinent to LTx-MV, as well as PGD, ARDS, and intraoperative MV and to synthesize these available data into recommendations. Based on the available evidence, we recommend lung-protective MV with low-tidal-volumes (≤6 mL/kg predicted body weight [PBW]) and positive end-expiratory pressure for the LTx-recipient. In our opinion, the MV strategy should be based on donor characteristics (donor PBW as a parameter of actual allograft size), rather than based on recipient characteristics; however this donor-characteristics-based protective MV is based on indirect evidence and requires validation in prospective clinical studies.
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Affiliation(s)
- Lindsey Barnes
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Robert M Reed
- Division of Pulmonary and Critical Care Medicine, University of Maryland
| | - Kalpaj R Parekh
- Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics
| | - Jay K Bhama
- Department of Thoracic and Cardiovascular Surgery, University of Iowa Hospitals and Clinics
| | - Tahuanty Pena
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Pennsylvania
| | | | - Gregory A Schmidt
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Julia A Klesney-Tait
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics
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Anesthetic management of a patient with a double inferior vena cava and pulmonary alveolar proteinosis who underwent bilateral living-donor lobar lung transplantation. J Anesth 2009; 23:583-6. [DOI: 10.1007/s00540-009-0803-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Accepted: 06/01/2009] [Indexed: 10/20/2022]
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Serra E, Feltracco P, Barbieri S, Forti A, Ori C. Transesophageal Echocardiography During Lung Transplantation. Transplant Proc 2007; 39:1981-2. [PMID: 17692671 DOI: 10.1016/j.transproceed.2007.05.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transesophageal echocardiography (TEE) is a semi-invasive monitoring technique increasingly used in cardiac surgery and in major noncardiac surgery for patients with known or supposed cardiac or coronary problems. During lung transplantation (LTx), the close interrelation between heart and lung function makes TEE an invaluable tool for instantly monitoring the physiopathological situation in the subsequent steps of the intervention. In patients scheduled for LTx, induction of anesthesia could be a dangerous moment with the possibility of cardiogenic shock if pulmonary hypertension (PH) exists; pneumatic tamponade is also possible in patients with emphysema caused by alpha(1)-antitrypsin deficiency, with subsequent cardiac insufficiency. One-lung ventilation is a critical phase during LTx; hypoxemia resulting from ventilation of a diseased dependent lung could impair heart oxygenation, particularly if tachycardia is present. Clamping of the pulmonary artery before pneumonectomy could exacerbate cardiac afterload, especially in patients with previous PH. High transmural pressure, linked with low systemic pressure, makes right ventricle (RV) perfusion pressure inadequate. Hypoxemia and PH are the most frequent causes of intraoperative RV decompensation. In this special setting, TEE is irreplaceable in informing the anesthesiologist about the correct time for extracorporeal oxygenation. Lung reperfusion brings with it the possibility of coronary gaseous embolism, easily detected with TEE. After LTx, TEE can be used to detect strictures, thrombi, or permeability of pulmonary venous anastomoses. To summarize, intraoperative TEE during LTx contributes to the immediate recognition of critical events and allows for rapid therapeutic interventions.
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Affiliation(s)
- E Serra
- Department of Pharmacology and Anesthesia, University Hospital of Padova, Padova, Italy.
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Feltracco P, Serra E, Barbieri S, Salvaterra F, Rizzi S, Furnari M, Brezzi M, Rea F, Ori C. Anesthetic Concerns in Lung Transplantation for Severe Pulmonary Hypertension. Transplant Proc 2007; 39:1976-80. [PMID: 17692670 DOI: 10.1016/j.transproceed.2007.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Lung transplantation has become a consolidated treatment for patients with severe pulmonary hypertension (PH). Several difficulties are encountered during the procedure in such candidates, who are still recognized as more severely affected by perioperative morbility and mortality than those undergoing lung transplantation for other diseases. Right ventricular (RV) enlargement with tricuspid regurgitation, small left ventricle (LV) with an asymmetric hypetrophic wall, interventricular septal shift toward the left, with ventricular stiffness and diastolic incompetence, are typical preoperative echocardiographic findings of end-stage PH. A smooth induction and tracheal intubation will help prevent hypertensive crisis in highly susceptible candidates. Uncompensated vasodilatation or myocardial depression caused by anesthetics and mechanical ventilation may be responsible for acute RV dysfunction associated with low systemic blood pressure. Resuscitation and emergency adoption of cardiopulmonary by-pass (CPB) has been described for near-fatal anesthesia induction. Cardiovascular instability can develop after institution of one-lung ventilation and pulmonary artery clamping. An acute increase in pulmonary pressure results in a decrease in RV ejection fraction and then in acute RV failure. Interdependence of the right and left ventricles occurs such that RV function can alter LV function. Early detection of impending circulatory and/or respiratory deterioration is warranted to prevent an irreversible decline in cardiac output, resulting in hazardous cardiac arrest. Inhaled nitric oxide represents the first choice for treatment of PH and RV failure associated with systemic hypotension during lung transplantation. Intraoperative situations requiring CPB must be identified before development of systemic shock, which represents a late ominous sign of RV failure.
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Affiliation(s)
- P Feltracco
- Department of Pharmacology and Anesthesia, University Hospital of Padova, Padova, Italy.
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Abstract
Anesthetic challenges regarding lung transplantation are related to the expanded spectrum of diseases for which lung transplantation is offered and to the interval changes in health status likely to occur as patients wait longer for an organ to become available. Particular attention to avoiding or reducing the impact of increases in pulmonary vascular resistance and right heart failure are important and may necessitate cardiopulmonary bypass. Intraoperative and postoperative ventilator management should account for differences in pulmonary compliance after the new lung is implanted. Minimizing intravenous fluids without compromising end organ perfusion may avoid or reduce postoperative respiratory insufficiency.
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Affiliation(s)
- Andrew L Rosenberg
- Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, MI 48109-0048, USA.
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Gómez FJ, Planas A, Ussetti P, Tejada JJ, Varela A. [Prognostic factors of early morbidity and mortality after lung transplantation]. Arch Bronconeumol 2003; 39:353-60. [PMID: 12890403 DOI: 10.1016/s0300-2896(03)75403-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite years of experience with lung transplantation, the rate of perioperative mortality remains high. The objective of this study was to look at our experience in the early postoperative period following lung transplantation in an effort to identify possible pre-, intra- and postoperative risk factors associated with mortality. PATIENTS AND METHODS A retrospective study of 68 consecutive patients receiving lung transplants over a period of 56 months. The conditions that led to transplantation were obstructive disease (40%), interstitial disease (33%) and suppurative disease (27%). Pre-, intra- and postoperative characteristics of donors and recipients were analyzed for their relation to morbidity and mortality. Statistical studies were done using SPSS 10.0 software. A p-value less than.05 was considered significant. Univariate analysis identified variables associated with the incidence of mortality in the postoperative recovery unit, and the variables with statistically significant associations were entered into multivariate analysis, using a logistic regression model to calculate odds ratio (OR) and 95% confidence intervals (CI). RESULTS No donor variables correlated with mortality. Patients with suppurative lung disease had a lower mortality rate (0% vs 30%; P = 0.04). Mortality was related to ischemic time longer than 300 minutes (OR = 2) and the use of extracorporeal circulation (OR = 4). A PaO2/FiO2 ratio less than 150 during the first 24 hours following transplantation (OR = 5) and reoperation due to bleeding (OR = 12) were the variables showing the highest correlations with mortality during the early postoperative period. CONCLUSIONS The mortality rate during the early postoperative period in our series was 22%. The survival rate was better in patients with suppurative lung disease. Bleeding that required reoperation and early graft dysfunction (defined in part by a PaO2/FiO2 ratio less than 150 during the first 24 hours) were the variables that best predicted death in the early postoperative period following lung transplantation.
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Affiliation(s)
- F J Gómez
- Servicio de Anestesiología y Reanimación. Hospital Universitario Clínica Puerta de Hierro. Madrid. España
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Rocca GD, Coccia C, Costa GM, Pompei L, Di Marco P, Pierconti F, Cappa M, Venuta F, Pietropaoli P. Is very early extubation after lung transplantation feasible? J Cardiothorac Vasc Anesth 2003; 17:29-35. [PMID: 12635057 DOI: 10.1053/jcan.2003.6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate donor graft function, intraoperative blood consumption, and oxygenation and hemodynamic stability in patients undergoing lung transplantation. DESIGN Prospective pilot study. SETTING University hospital. PARTICIPANTS Forty-three patients undergoing lung transplantation from January 1999 to June 2001. INTERVENTIONS Hemodynamic monitoring, early extubation, and noninvasive ventilation criteria. MEASUREMENTS AND MAIN RESULTS The 31 nonearly extubated patients showed a lower PaO(2)/fraction of inspired oxygen (F(I)O(2)), a higher mean pulmonary arterial pressure, extravascular lung-water index (EVLWI) and vasoactive drug support (norepinephrine), and more blood products consumption than 12 early extubated patients at the end of surgery. Seven of 12 early extubated patients did not show any signs of respiratory failure after tracheal extubation; they were alert and able to perform deep breathing exercise and coughing. In the other 5 patients, hypoxemia, hypercapnia, and an increase of respiratory rate >30 breaths/min were observed. The intermittent application of noninvasive pressure ventilation by face mask avoided endotracheal intubation. CONCLUSION The use of a short-acting anesthetic drug, appropriate intraoperative extubation criteria, epidural analgesia, and postoperative noninvasive ventilation make early extubation of lung-transplanted patients possible and effective.
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Abstract
PURPOSE OF THE REVIEW An adequate cardiac preload is essential in the treatment of critically ill patients. During anesthesia for thoracic surgery, volume and vasoactive therapy to optimize cardiac output, oxygen delivery (tissue perfusion) and to avoid pulmonary edema is a central therapeutic aspect. Cardiac preload has been estimated with different techniques in clinical practice, even though studies performed on thoracic anesthesia are lacking. RECENT FINDINGS We analyze the conventional pulmonary artery catheter, transesophageal echocardiography and the transpulmonary indicator dilution technique as preload monitoring devices with their indications and limits in thoracic anesthesia. SUMMARY The pulmonary artery catheter is confirmed as a fundamental device particularly in patients with pulmonary hypertension. For transesophageal echocardiography monitoring, the dependency on operator experience, the low repeatability and the high costs limit its interpretation and diffusion in clinical practice. During lung transplantation, Swan Ganz catheter monitoring is recommended. The optimization of fluid balance and vasoactive drug administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system during anesthesia for thoracic surgery when intravascular volume management is a primary objective.
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Della Rocca G, Costa GM, Coccia C, Pompei L, Di Marco P, Pietropaoli P. Preload Index: Pulmonary Artery Occlusion Pressure Versus Intrathoracic Blood Volume Monitoring During Lung Transplantation. Anesth Analg 2002. [DOI: 10.1213/00000539-200210000-00009] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Della Rocca G, Costa GM, Coccia C, Pompei L, Di Marco P, Pietropaoli P. Preload index: pulmonary artery occlusion pressure versus intrathoracic blood volume monitoring during lung transplantation. Anesth Analg 2002; 95:835-43, table of contents. [PMID: 12351254 DOI: 10.1097/00000539-200210000-00009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED In this study, during lung transplantation, we analyzed a conventional preload index, the pulmonary artery occlusion pressure (PAOP), and a new preload index, the intrathoracic blood volume index (ITBVI), derived from the single-indicator transpulmonary dilution technique (PiCCO System), with respect to stroke volume index (SVIpa). We also evaluated the relationships between changes (Delta) in ITBVI and PAOP and DeltaSVIpa during lung transplantation. The reproducibility and precision of all cardiac index measurements obtained with the transpulmonary single-indicator dilution technique (CIart) and with the pulmonary artery thermodilution technique (CIpa) were also determined. Measurements were made in 50 patients monitored with a pulmonary artery catheter and with a PiCCO System at six stages throughout the study. Changes in the variables were calculated by subtracting the first from the second measurement (Delta(1)) and so on (Delta(1) to Delta(5)). The linear correlation between ITBVI and SVIpa was significant (r(2)=0.41; P < 0.0001), whereas PAOP poorly correlated with SVIpa (r(2) = -0.01). Changes in ITBVI correlated with changes in SVIpa (Delta(1), r(2) = 0.30; Delta(2), r(2) = 0.57; Delta(4), r(2) = 0.26; and Delta(5), r(2) = 0.67), whereas PAOP failed. The mean bias between CIart and CIpa was 0.15 l. min(-1). m(-2) (1.37). In conclusion, ITBVI is a valid indicator of cardiac preload and may be superior to PAOP in patients undergoing lung transplantation. IMPLICATIONS The assessment of intrathoracic blood volume index (ITBVI) by the transpulmonary single-indicator technique is a useful tool in lung transplant patients, providing a valid index of cardiac preload that may be superior to pulmonary artery occlusion pressure. However, more prospective, randomized studies are necessary to evaluate the role and limitations of this technique.
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Affiliation(s)
- Giorgio Della Rocca
- Istituto di Anestesiologia e Rianimazione, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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Maslow A, Bert A, Schwartz C, Mackinnon S. Transesophageal Echocardiography in the noncardiac surgical patient. Int Anesthesiol Clin 2002; 40:73-132. [PMID: 11910251 DOI: 10.1097/00004311-200201000-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Andrew Maslow
- Rhode Island Hospital, Brown University Medical Center, Providence 02903, USA
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McQuitty CK. Con: Inhaled nitric oxide should not be used routinely in patients undergoing lung transplantation. J Cardiothorac Vasc Anesth 2001; 15:790-2. [PMID: 11748535 DOI: 10.1053/jcan.2001.28342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C K McQuitty
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Texas Medical Branch, 300 University Boulevard, Galveston, TX 77555-0591, USA.
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Rocca GD, Coccia C, Pompei L, Ruberto F, Venuta F, De Giacomo T, Pietropaoli P. Hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide and inhaled aerosolized prostacyclin. J Cardiothorac Vasc Anesth 2001; 15:224-7. [PMID: 11312484 DOI: 10.1053/jcan.2001.21974] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate hemodynamic and oxygenation changes of combined therapy with inhaled nitric oxide (iNO) and inhaled aerosolized prostcyclin (IAP) during lung transplantation. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS Ten patients scheduled for lung transplantation. INTERVENTIONS Ten patients, with a mean age of 38 years (range, 24 to 56 years), were scheduled for lung transplantation (2 single-lung transplantations and 8 double-lung transplantations). During first lung implantation with single-lung perfusion and ventilation, hemodynamic and oxygenation data were analyzed in 3 phases: (1) baseline, 5 minutes after pulmonary artery clamping; (2) inhaled NO phase, 15 minutes after inhaled NO administration (20 ppm) in 100% oxygen; and (3) IAP-inhaled NO phase, 15 minutes after combined administration of inhaled NO (20 ppm) and IAP (10 ng/kg/min) in 100% oxygen. MEASUREMENTS AND MAIN RESULTS During the inhaled NO phase, reductions of mean pulmonary arterial pressure (p < 0.05) and intrapulmonary shunt (p < 0.05) were noted. After the start of prostacyclin inhalation, a further decrease in mean pulmonary arterial pressure (p < 0.05) was observed. PaO2/FIO2 increased during the IAP-inhaled NO phase (p < 0.05), whereas intrapulmonary shunt decreased (p < 0.05). CONCLUSION This study confirms the action of inhaled NO as a selective pulmonary vasodilator during lung transplantation. Combined therapy with IAP and inhaled NO increases the effects on pulmonary arterial pressure and oxygenation compared with inhaled NO administered alone without any systemic changes.
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Affiliation(s)
- G D Rocca
- Istituto di Anestesiologia e Rianimazione, Cattedra di Chirurgia Toracica, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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Della Rocca G, Coccia C, Costa MG, Pompei L, Di Marco P, Vizza CD, Venuta F, Rendina EA, Pietropaoli P, Cortesini R. Inhaled areosolized prostacyclin and pulmonary hypertension during anesthesia for lung transplantation. Transplant Proc 2001; 33:1634-6. [PMID: 11267451 DOI: 10.1016/s0041-1345(00)02623-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- G Della Rocca
- Instituto di Anestesiologia e Rianimazione, University of Rome "La Sapienza," Azienda Ospedaliera Policlinico Umberto I, Rome, Italy.
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Iwase S, Yamamoto K, Miwa C, Kamiya A, Niimi Y, Fu Q, Mano T. Skin sympathetic neuroeffector response is attenuated dose-dependently by systemic prostaglandin E1 injection in humans. Neurosci Lett 2000; 292:191-4. [PMID: 11018309 DOI: 10.1016/s0304-3940(00)01463-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To clarify the effects of prostaglandin E1 (PGE1) on the vasoconstrictive responses, we compared the correlation between the amplitude of integrated skin sympathetic nerve activity (SSNA) and per cent reduction in skin blood flow (SBF) before and after the infusion of lipo PGE1 and placebo (bolus one-shot infusion, single blind study), and constant rate infusion of PGE1 (10 and 50 ng kg(-1) min(-1) by infusion pump, dose-dependency study) in ten healthy men. SSNA was recorded microneurographically from the median nerve simultaneously with SBF by laser Doppler flowmetry at the index fingertip. The measurement was conducted 30 min after injection of lipo PGE1 or placebo, and during the drip infusion of 10 and 50 ng kg(-1) min(-1) of PGE1 with maneuvers to enhance SSNA. The resting and activated skin blood flow were not significantly different between 10 ng lipo PGE1 and placebo administration, and between baseline and 10, 50 ng kg(-1) min(-1) of PGE1 injection. The vascular response, defined as the slope of regression line between logarithm of amplitude of integrated SSNA bursts and the reduction in SBF, was significantly suppressed by injection of lipo PGE1 as compared with that by placebo. It was also decreased dose-dependently by the constant rate infusion of PGE1 (10 and 50 ng kg(-1) min(-1)). We concluded that the intravenous injection of PGE1 attenuates vasoconstrictive responses to SSNA, and analysis of the relations between SSNA and vasoconstrictive response, i.e. the neuroeffector response, is suggested to be an important tool to assess the drug effect.
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Affiliation(s)
- S Iwase
- Department of Autonomic Neuroscience, Research Institute of Environmental Medicine, Nagoya University, Furo-cho, Chikusa-ku, 464-8601, Nagoya, Japan.
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Abstract
Increasing numbers of individuals leading normal lives have transplanted organs. They may appear in any hospital for treatment of trauma or general diseases. Common anaesthesia methods can be used for these patients, but safe conduct of anaesthesia requires knowledge of the immunosuppression, risk factors, and altered physiology or drug actions. This article reviews the anaesthesia-related literature on patients with transplanted organs.
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Affiliation(s)
- H J Toivonen
- Department of Anaesthesia, University of Helsinki, Finland.
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Abstract
Anesthetic technique for pulmonary transplantation varies with recipient's underlying lung disease, procedure performed and regional practice. The pulmonary allograft is vulnerable to mechanical and biochemical injury throughout the harvesting, preservation and engraftment procedures. Mechanisms of allograft injury are reviewed, with suggestions for incorporation of strategies to minimize injury into clinical practice. Particular emphasis is placed on the use of nitric oxide for treatment of reperfusion injury.
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Affiliation(s)
- K M McRae
- Department of Anaesthesia, Toronto General Hospital, Toronto, Ontario, Canada.
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Briegel J, Groh J, Haller M. Perioperative management of patients undergoing lung transplantation. Curr Opin Anaesthesiol 1998; 11:51-9. [PMID: 17013205 DOI: 10.1097/00001503-199802000-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review focuses on recent developments in the perioperative management of patients undergoing lung transplantation. Relevant current literature and the experience of the Munich Lung Transplant Group were taken into consideration. Recent advances include the use of inhalational nitric oxide for the treatment of early graft dysfunction and the use of aerosolized cyclosporine for the treatment of recurrent and steroid-resistant acute rejection. Opportunistic infections remain a major source of morbidity and mortality in lung transplant recipients.
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Affiliation(s)
- J Briegel
- Department of Anaesthesiology, Ludwig-Maximilians-Universität München, Klinikum Grosshadern, Munich, Germany
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