Anesthesia for bilateral sequential lung transplantation: Experience of 64 cases

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 11; no. 2; pp. 177 - 183
• Main Authors: Myles, Paul S., Weeks, Anthony M., Buckland, Mark R., Silvers, Andrew, Bujor, Michael, Langley, Mark
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.04.1997; Elsevier
• Subjects: Adult; Anesthesia; Anesthesia - methods; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; bilateral sequential lung transplantation; Biological and medical sciences; Cardiopulmonary Bypass; dynamic hyperinflation; Female; Humans; Lung Transplantation; Male; Medical sciences; Middle Aged; nitric oxide; outcome; Thoracic and cardiovascular surgery. Cardiopulmonary bypass; dynamic hyperinflation; nitric oxide; bilateral sequential lung transplantation; outcome; anesthesia; Human; Lung disease; Prognosis; Respiratory disease; Surgery; Lung; General anesthesia; Bilateral; Transplantation
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1016/S1053-0770(97)90210-X

Objectives: To review the experience of anesthesia for bilateral sequential lung transplantation (BSLTx) and describe factors associated with outcome. Design: Case series. Setting: University hospital. Participants: Sixty-four adult patients undergoing BSLTx. Interventions: Descriptive and inferential statistical analysis. Measurements and Main Results: Details of anesthetic technique, patient, and perioperative characteristics are presented. Mean (SD) lung allograft ischemic times were 320 (81) minutes for the first lung and 446 (93) minutes for the second lung. Mean (SD) duration of surgery was 8.5(2) hours, and median time to extubation was 28 hours. There was a reduction in the use of cardiopulmonary bypass, from 10 of 19 (53%) in 1992 to 1993 to 10 of 45 (22%) in 1994 to 1996, p = 0.016. There was an association between time to extubation and duration of surgery (Spearman rank correlation, p = 0.33, p = 0.008), but no association with intraoperative fluid administration ( p = 0.18, p = 0.16), or inotrope requirements ( p = 0.06, p = 0.65). Predictors of in-hospital mortality were preoperative renal impairment ( p = 0.034), early reoperation ( p = 0.005), and delay in extubation ( p = 0.013); and for 12-month mortality was patient age ( p = 0.01). The actuarial survival rates were 90%, 73%, and 58% at 30 days, 1 year, and 2 years, respectively. Conclusions: Anesthesia for BSLTx is a most challenging procedure, for which maintenance of tissue oxygenation and right ventricular perfusion are essential. Recent advances include use of inhaled nitric oxide, ventilator management that reduces dynamic hyperinflation, and permissive hypercapnia. Analysis of outcome from a large case series such as this enables the anesthesiologist to be more aware of the important features of anesthesia for BSLTx, as well as identify potential areas of improvement.