TY - CHAP M1 - Book, Section TI - Chapter 19. Anesthesia for Lung Transplantation A1 - Pabich, Wendy L. A1 - Podgoreanu, Mihai V. A2 - Barbeito, Atilio A2 - Shaw, Andrew D. A2 - Grichnik, Katherine Y1 - 2012 N1 - T2 - Thoracic Anesthesia AB - Preoperative respiratory assessment should include pulmonary function tests, ventilation/perfusion (V/Q) scans, and an arterial blood gas. The patient's ability to tolerate one-lung ventilation can be determined by V/Q scan, and if both lungs are being transplanted the lung with less perfusion should be transplanted first.Cardiac function should be assessed with particular attention paid to evaluation of right ventricular (RV) function. Elevated pulmonary arterial pressures can precipitate RV failure, and may greatly influence the decision to attempt transplantation with or without CPB.The newly transplanted lung should be ventilated with as low a FiO2 as possible, ideally room air, to minimize damage by oxygen free radicals. Barotrauma to the new lung can be avoided by keeping inspiratory pressures less than 25 cm H2O and PEEP less than 10 cm H2O.Hemodynamic instability or refractory hypoxemia may deem cardiopulmonary bypass necessary and typically occurs at one of three critical phases of the operation: (a) after pulmonary artery clamping during the first transplant; (b) after perfusing the first allograft but before starting the second lung; and, (c) after pulmonary artery clamping during the second transplant. SN - PB - The McGraw-Hill Companies CY - New York, NY Y2 - 2024/11/13 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=56785922 ER -