ANESTHESIA, CYSTIC-FIBROSIS AND ORGAN-TRANSPLANTATION

Patients affected by cystic fibrosis (CF) may present several problems if undergone general anaesthesia, according to the surgical procedure , to the age and to the clinical status of patients. Lung or liver tra nsplantation offer a <<chance>> for patients with respiratory or hepat ic insufficiency. In our institution 13 lung transplantations and 4 li ver transplantations were performed in pts affected by CF. From Novemb er 1996 to November 1997, 13 patients underwent bilateral sequential s ingle lung transplantation (BS-SLTx) Anesthesia was induced with propo fol, fentanyl, scopolamine and/or midazolam, and/or lorazepam, and mai ntained with isoflurane, fentanyl in O-2 100%. Vecuronium bromide was used as muscle relaxant. For intubation a single lumen tube was introd uced to perform a bronchial toilette, then a left endobronchial tube ( Robert Shaw) was positioned. Hemodynamic management was performed with prostaglandin E-1, norepinephrine, ephedrine, dobutamine, dopamine an d inhaled nitric oxide (iNO). An adequate pharmacological support with pulmonary vasodilators, inotropic and systemic vasoactive drugs led t o successful lung transplantation with cardio-pulmonary bypass. From A pril 1996 to May 1997, four patients affected by CF with end-stage liv er disease with mild to moderate pulmonary abnormalities underwent liv er transplantation. The patients received pancreatic enzyme and two ha d insulin-dependent diabetes mellitus. General anaesthesia was induced with fentanyl, thiopental and pancuronium, and maintained with isoflu rane supplemented by fentanyl, thipental and pancuronium, and maintain ed with isoflurane supplemented by fentanyl in O-2 : air (FiO(2) = 0.5 ). After the intubation and at the end of the procedure, all patients received a bronchial toilette through fiberoptic bronchoscopy. All pat ients were successfully transplanted, PaO2 increased proportionally to the decreasing in Qsp/Qt during intraoperative time of the transplant ation. The follow-up at 1 year showed fev(1) and FVC improved from pre operative time in all patients.