RT Book, Section
A1 Pabich, Wendy L.
A1 Podgoreanu, Mihai V.
A2 Barbeito, Atilio
A2 Shaw, Andrew D.
A2 Grichnik, Katherine
SR Print(0)
ID 56785922
T1 Chapter 19. Anesthesia for Lung Transplantation
T2 Thoracic Anesthesia
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-162566-1
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56785922
RD 2024/04/18
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.