Anesthesia for Lung Transplantation

2019 ◽  
pp. 322-329
Author(s):  
J. Devin Roberts
Keyword(s):  
Lung Transplantation ◽  
Transesophageal Echocardiography ◽  
Gold Standard ◽  
Anesthetic Management ◽  
Survival Rates ◽  
Anesthesia Care ◽  
Lung Isolation ◽  
The Past ◽  
Lung Transplants ◽  
End Stage

Since the first human procedure in 1963, lung transplantation has become the gold standard treatment of a variety of end-stage lung diseases. With over 4000 lung transplants performed in 2015 and steadily improving survival rates over the past three decades, anesthetic management of patients undergoing lung transplant can significantly contribute to patient outcomes. Anesthesia care for lung transplantation can be both complex and clinically challenging. Anesthesiologists taking part in these procedures need to have specific skills regarding thoracic and cardiac anesthesia. There are both technical and physiological challenges, such as achieving adequate lung isolation and oxygenation, interpretation and use of transesophageal echocardiography, and the management of respiratory and myocardial impairments. This chapter provides an overview of these perioperative anesthetic management considerations utilizing a problem-based format.

scholarly journals Recent advances in lung transplantation

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1684 ◽  
Author(s):  
Keith C Meyer
Keyword(s):  
Lung Transplantation ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Donor Pool ◽  
Post Transplant ◽  
Antibody Mediated Rejection ◽  
The Past ◽  
End Stage ◽  
Transplant Complications

Lung transplantation can improve quality of life and prolong survival for individuals with end-stage lung disease, and many advances in the realms of both basic science and clinical research aspects of lung transplantation have emerged over the past few decades. However, many challenges must yet be overcome to increase post-transplant survival. These include successfully bridging patients to transplant, expanding the lung donor pool, inducing tolerance, and preventing a myriad of post-transplant complications that include primary graft dysfunction, forms of cellular and antibody-mediated rejection, chronic lung allograft dysfunction, and infections. The goal of this manuscript is to review salient recent and evolving advances in the field of lung transplantation.

Role of autoimmunity in organ allograft rejection: a focus on immunity to type V collagen in the pathogenesis of lung transplant rejection

2004 ◽  
Vol 286 (6) ◽  
pp. L1129-L1139 ◽  
Author(s):  
Tina L. Sumpter ◽  
David S. Wilkes
Keyword(s):  
Lung Transplantation ◽  
Lung Transplant ◽  
Transplant Rejection ◽  
Survival Rates ◽  
Definitive Treatment ◽  
Solid Organ ◽  
Type V Collagen ◽  
End Stage ◽  
Type V

Lung transplantation is the only definitive treatment modality for many forms of end-stage lung disease. However, the lung is rejected more often than any other type of solid organ allograft due to chronic rejection known as bronchiolitis obliterans (BO). Indeed, BO is the primary reason why the 5- and 7-yr survival rates are worse for the lung than for any other transplanted organ. Alloimmunity to donor antigens is established as the primary mechanism that mediates rejection responses. However, newer immunosuppressive regimens designed to abrogate alloimmune activation have not improved survival. Therefore, these data suggest that other antigens, unrelated to donor transplantation antigens, are involved in rejection. Utilizing human and rodent studies of lung transplantation, our laboratory has documented that a native collagen, type V collagen [col(V)], is a target of the rejection response. Col(V) is highly conserved; therefore, these data indicate that transplant rejection involves both alloimmune and autoimmune responses. The role of col(V) in lung transplant rejection is described in this review article. In addition, the potential role of regulatory T cells that are crucial to modulating autoimmunity and alloimmunity is also discussed.

scholarly journals Anesthetic considerations for awake craniotomy

2020 ◽  
Vol 15 (3) ◽  
pp. 269-274
Author(s):  
Seung Hyun Kim ◽  
Seung Ho Choi
Keyword(s):  
Brain Mapping ◽  
Gold Standard ◽  
Anesthetic Management ◽  
Standard Of Care ◽  
Awake Craniotomy ◽  
Anesthesia Care ◽  
Surgical Team ◽  
Monitored Anesthesia Care ◽  
Eloquent Areas ◽  
Anesthetic Considerations

Awake craniotomy is a gold standard of care for resection of brain tumors located within or close to the eloquent areas. Both asleep-awake-asleep technique and monitored anesthesia care have been used effectively for awake craniotomy and the choice of optimal anesthetic approach is primarily based on the preferences of the anesthesiologist and surgical team. Propofol, remifentanil, dexmedetomidine, and scalp nerve block provide the reliable conditions for intraoperative brain mapping. Appropriate patient selection, adequate perioperative psychological support, and proper anesthetic management for individual patients in each stage of surgery are crucial for procedural safety, success, and patient satisfaction.

scholarly journals Lessons learned from extracorporeal membrane oxygenation as a bridge to lung transplantation

2014 ◽  
Author(s):  
Vladimir Shumaster ◽  
Oliver Jawitz ◽  
David Yuh ◽  
Pramod Bonde
Keyword(s):  
Postoperative Complications ◽  
Extracorporeal Membrane Oxygenation ◽  
Lung Transplantation ◽  
Survival Rates ◽  
Length Of Hospital Stay ◽  
Lessons Learned ◽  
Control Group ◽  
Membrane Oxygenation ◽  
Lung Transplants ◽  
United Network

Extracorporeal membrane oxygenation (ECMO) has been used infrequently as a bridge to lung transplantation due to lack of consensus and data regarding the benefits of such a strategy. We present data from the United Network of Organ Sharing (UNOS) database on the outcomes of patients bridged to lung transplantation with ECMO. We used the UNOS database to analyze data between January 1, 2000 and December 31, 2011. During this time 14,263 lung transplants were performed, of which 143 (1.0%) were bridged using ECMO. Patients on ECMO as a bridge to lung transplantation were compared to those transplanted without prior ECMO support. Demographics, survival rates, complications, and rejection episodes were compared between the two groups. The 30-day, 6-month, 1-year, 3-year, and 5-year survival rates were 69%, 56%, 48%, 26%, and 11%, respectively, for the ECMO bridge group and 95%, 88%, 81%, 58%, and 38% respectively, for the control group (p ≤ 0.01). The ECMO group incurred higher rate of postoperative complications, including airway dehiscence (4% vs. 1%, p ≤ 0.01), stroke (3% vs. 2%, p ≤ 0.01), infection (56% vs. 42%, p ≤ 0.01), and pulmonary embolism (10% vs. 0.6%, p ≤ 0.01). The length of hospital stay was longer for the ECMO group (41 vs. 25 days, p ≤ 0.01), and they were treated for rejection more often (49% vs. 36%, p = 0.02). The use of ECMO as a bridge to lung transplantation is associated with significantly worse survival and more frequent postoperative complications. Therefore, we advocate very careful patient selection and cautious use of ECMO.

scholarly journals Lung transplantation: how we do it

2021 ◽  
Author(s):  
John Santosh Murala ◽  
Hashim Muhammad Hanif ◽  
Matthias Peltz ◽  
Sreekanth Reddy Cheruku ◽  
Lynn Custer Huffman ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Pulmonary Disease ◽  
Median Survival ◽  
Gold Standard ◽  
Lung Transplant ◽  
Transplant Program ◽  
The World ◽  
End Stage

AbstractLung transplantation is considered the gold standard for patients with chronic end-stage pulmonary disease. However, due to the complexity of management and relatively lower median survival as compared to other solid organs, many programs across the world have been slow to adopt the same. In our institution, we started lung transplantation in September 1990. And since then, we performed close to 900 lung transplantations. Here, we describe in detail the operative steps adopted in our institution for a successful lung transplantation. There have been very few variations over the years. We believe that having a standardized technique is one of the important features for success of a lung transplant program.

scholarly journals Anesthetic management of lung transplantation in a patient with end-stage COVID-19 pneumonia

Medicine ◽  
2021 ◽  
Vol 100 (25) ◽  
pp. e26468
Author(s):  
Shao-Hui Guo ◽  
Ang Li ◽  
Peng-Fei Yin ◽  
Sheng-Mei Zhu ◽  
Yong-Xing Yao
Keyword(s):  
Lung Transplantation ◽  
Anesthetic Management ◽  
End Stage

scholarly journals Lung and liver transplantation in patients with alpha-1 antitrypsin deficiency

2021 ◽  
Vol 12_suppl ◽  
pp. 204062232110029
Author(s):  
Martin R. Zamora ◽  
Ali Ataya
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Respiratory Failure ◽  
Lung Transplantation ◽  
Lung Disease ◽  
Cause Of Death ◽  
Treatment Option ◽  
Survival Rates ◽  
Alpha 1 Antitrypsin ◽  
End Stage

Alpha-1 antitrypsin (AAT) augmentation is effective in slowing the progression of emphysema due to AAT deficiency (AATD) but cannot prevent eventual progression to end-stage lung disease and complete respiratory failure, which is the leading cause of death for individuals with severe AATD. When patients develop end-stage lung disease, lung transplantation is the only treatment option available, and this can improve lung physiology and patient health status. The available data suggest that survival rates for lung transplantation are significantly higher for patients with AATD-related chronic obstructive pulmonary disease (COPD) compared with non-AATD-related COPD, but, conversely, there is a higher risk of common post-lung transplant complications in patients with AATD versus non-AATD COPD. Nevertheless, lung transplantation (single and bilateral) is favorable for patients with AATD. After respiratory failure, the second leading cause of death in patients with AATD is liver disease, for example, cirrhosis and hepatocellular carcinoma, caused by the accumulation of mutant forms of AAT retained within the liver. As with lung disease, the only treatment option for end-stage liver disease is liver transplantation. Survival rates for patients with AATD undergoing liver transplantation are also favorable, and patients, particularly pediatric patients, have benefitted from advancements in peri-/post-surgical care. As the majority of AAT is produced by the liver, the AAT phenotype of the recipient becomes that of the donor, meaning that AAT serum levels should be normalized (if the donor is AAT-replete), halting further lung and liver disease progression. However, post-liver transplant respiratory function may continue to decline in line with normal age-related lung function decline. In the most severe cases, where patients have simultaneous end-stage lung and liver disease, combined lung and liver transplantation is a treatment option with favorable outcomes. However, there is very little information available on this procedure in patients with AATD.

scholarly journals Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery

2013 ◽  
Vol 1 (2) ◽  
pp. 48-56 ◽  
Author(s):  
Stephen A Esper
Keyword(s):  
Pulmonary Hypertension ◽  
Postoperative Complications ◽  
Lung Transplantation ◽  
Lung Disease ◽  
Transesophageal Echocardiography ◽  
Patient Management ◽  
Preoperative Evaluation ◽  
Transplantation Surgery ◽  
End Stage

ABSTRACT Lung transplantation is the only option for patients with end-stage lung disease. Chronic obstructive lung disease, idiopathic pulmonary fibrosis, cystic fibrosis and primary pulmonary hypertension are few common indications for lung transplantation. Patients with end-stage lung disease may have pre-existing cardiovascular compromise related to pulmonary hypertension and other cardiovascular lesions, such as coronary artery disease or valvular heart disease. Preoperative evaluation and optimization of hemodynamics is expected to improve outcomes from lung transplantation. Intraoperative hemodynamic instability is common during lung transplantation and requires highest level of cardiovascular monitoring. After transplantation, vascular anastomosis should be evaluated for flow patterns to rule out obstruction from stenosis or thrombosis. Postoperative complications are common and include bleeding, cardiac failure and hypoxemia from right to left shunt. Primary graft dysfunction may necessitate mechanical cardiorespiratory support. Transesophageal echocardiography plays a central role in preoperative evaluation, intraoperative hemodynamic management, evaluation of pulmonary vascular anastomosis, diagnosis of postoperative complications and also in the critical care management of mechanical cardiorespiratory support. How to cite this article Subramaniam K, Esper SA. Role of Transesophageal Echocardiography in Perioperative Patient Management of Lung Transplantation Surgery. J Perioper Echocardiogr 2013;1(2):48-56.

scholarly journals Molecular Methods for the Diagnosis of Invasive Candidiasis

2020 ◽  
Vol 6 (3) ◽  
pp. 101 ◽  
Author(s):  
Iris Camp ◽  
Kathrin Spettel ◽  
Birgit Willinger
Keyword(s):  
Blood Culture ◽  
Invasive Candidiasis ◽  
Gold Standard ◽  
Survival Rates ◽  
Molecular Methods ◽  
Essential Factor ◽  
The Past ◽  
Invasive Infections ◽  
Time Required ◽  
Prompt Diagnosis

Invasive infections caused by members of the genus Candida are on the rise. Especially patients in intensive care units, immunocompromised patients, and those recovering from abdominal surgery are at risk for the development of candidemia or deep-seated candidiasis. Rapid initiation of appropriate antifungal therapy can increase survival rates significantly. In the past, most of these infections were caused by C. albicans, a species that typically is very susceptible to antifungals. However, in recent years a shift towards infections caused by non-albicans species displaying various susceptibly patterns has been observed and the prompt diagnosis of the underlying species has become an essential factor determining the therapeutic outcome. The gold standard for diagnosing invasive candidiasis is blood culture, even though its sensitivity is low and the time required for species identification usually exceeds 48 h. To overcome these issues, blood culture can be combined with other methods, and a large number of tests have been developed for this purpose. The aim of this review was to give an overview on strengths and limitations of currently available molecular methods for the diagnosis of invasive candidiasis.

scholarly journals Lung Transplantation: The State of the Airways

2016 ◽  
Vol 140 (3) ◽  
pp. 241-244 ◽  
Author(s):  
Aliya N. Husain ◽  
Edward R. Garrity
Keyword(s):  
Lung Transplantation ◽  
Bronchiolitis Obliterans ◽  
Review Literature ◽  
Definitive Treatment ◽  
Term Survival ◽  
Chronic Lung Allograft Dysfunction ◽  
Allograft Dysfunction ◽  
Restrictive Allograft Syndrome ◽  
Lung Transplants ◽  
End Stage

Context Lung transplantation has become a viable option for definitive treatment of several end-stage lung diseases for which there are no other options available. However, long-term survival continues to be limited by chronic lung allograft dysfunction, which primarily affects the airways. Objective —To highlight the complications occurring mainly in the airways of the lung transplant recipient from the early to late posttransplant periods. Data Sources Review literature focusing on the airways in patients with lung transplants and clinical experience of the authors. Conclusions Postsurgical complications and infections of the airways have decreased because of better techniques and management. Acute cellular rejection of the airways can be distinguished from infection pathologically and on cultures. Separating small from large airways need not be an issue because both are risk factors for bronchiolitis obliterans. Grading of airway rejection needs to be standardized. Chronic lung allograft dysfunction consists of both bronchiolitis obliterans and restrictive allograft syndrome, neither of which can be treated very effectively at present.

Sign in / Sign up

Export Citation Format

Share Document