ANESTHESIA FOR NONCARDIAC SURGERY IN HEART-TRANSPLANTED PATIENTS

This review documents the anaesthetic management, haemodynamic functio n and outcome in 18 of 86 heart-transplanted recipients, who returned for 32 non-cardiac surgical procedures at the Toronto Hospital from 19 85 to 1990. General anaesthesia was administered in eight of the 27 el ective operations and four of the five emergency operations. Induction medications included thiopentone (2-4 mg . kg-1) fentanyl (1-7 mug . kg-1) and succinylcholine (1-1.5 mg . kg-1). Anaesthesia was maintaine d with a combination of oxygen/nitrous oxide and isoflurane or enflura ne Muscle relaxation was maintained with vecuronium or pancuronium. No delayed awakening or unplanned postoperative ventilation was observed Neurolept-anaesthesia anaesthesia was administered to 63.0% and 20.0% of the elective and emergency operations, respectively. The anaesthet ics included fentanyl (25-100 mug) and midazolam (0.5-1.5 mg) or diaze muls (2.5-5.0 mg). Spinal anaesthesia (75 mg lidocaine) was administer ed to only two of the 27 elective operations. No important haemodynami c changes were observed in any anaesthetic group, but lower systolic B P was found after induction and during maintenance periods in the pati ents who received general anaesthesia than in those who received neuro lept-anaesthesia However, no anaesthesia-related morbidity or mortalit y was noted. This suggests that general, neurolept- and spinal anaesth esia do not affect haemodynamic function or postoperative outcome in h eart-transplanted recipients undergoing subsequent non-cardiac surgery .