PERIOPERATIVE ANESTHETIC CONSIDERATIONS FOR PATIENTS UNDERGOING LUNG TRANSPLANTATION

Purpose: Five thousand, two hundred and eight lung transplants were pe rformed worldwide before April, 1996. This review will discuss lung tr ansplantation from an historical perspective, its indications, donor a nd recipient selection criteria, donor lung preparation, surgical cons iderations, perioperative anaesthetic management, and associated morbi dity and mortality. Source: Recent literature on perioperative anaesth etic management of lung transplantation and experience from internatio nal centres including tile Toronto Lung Transplant Group and the St. L ouis Lung Transplant Group. Principal findings: Lung transplantation c omprises of a family of operations, including single lung transplant, bilateral single lung transplant, lobar transplant and block heart-lun g transplant. Improved donor lung preservation techniques have increas ed the duration of cold ischaemic time. The advent of bilateral single lung transplant has decreased the requirement for cardiopulmonary byp ass, and airway complications have been reduced by adoption of the tel escoping bronchial anastomoses. Advances in perioperative monitoring ( including transoesophgeal echocardiography), pulmonary vasodilators (e .g., nitric oxide and prostaglandin E(1)), cardiopulmonary bypass and ventilatory management, and a better understanding of the pathophysiol ogical processes during the procedure have improved perioperative anae sthetic management. Also, advances in broad spectrum antibiotics and i mmunosuppressant drugs have improved the outcome by better management of the complications of infection and rejection. Conclusion: Lung tran splantation improves the quality of life with marginal improvement in life expectancy of the recipients. it is an expensive procedure requir ing continued resources for long term management of these patients.