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Lung transplantation anesthesia

Mohamed Ghalayini, Pierre-Yves Brun, Pascal Augustin, Elise Guivarch, Marie Pierre Dilly, Sophie Provenchere, Pierre Mordant, Yves Castier, Philippe Montravers, Dan Longrois
Competitive flows syndrome result in severe regional hypoxemia when the deoxygenated flow from the native left ventricle (LV) competes with oxygenated flow from extracorporeal life support (ECLS) pump with potentially severe consequences for the cerebral and coronary circulations. Fast correction of hypoxemia could be obtained by decreasing native LV flow by infusion of a short-acting beta-blocker (esmolol). Our purpose was to retrospectively review the efficacy of esmolol in this situation and hypothesize on the potential mechanisms of action and the associated risks...
September 2016: Journal of Extra-corporeal Technology
Dongdong Yuan, Guangjie Su, Yue Liu, Xinjin Chi, Jiayu Feng, Qianqian Zhu, Jun Cai, Gangjian Luo, Ziqing Hei
BACKGROUND: Postoperative acute lung injury (ALI) is a severe complication after liver transplantation, which influences patient survival rate obviously. However, its mechanisms are unclear and effective therapies are still lacking. The current study focused on effects of propofol on liver transplantation-induced ALI and whether its underlying mechanism was relative with connexin43 (Cx43) alternation. The authors postulated that endotoxin induced enhancement of Cx43 gap junction (GJ) plays a critical role in mediating post liver transplantation ALI and that pretreatment with the anesthetic propofol, known to inhibit gap junction, can confer effective protection...
2016: Journal of Translational Medicine
Daria M Moaveni, Jennifer H Cohn, Katherine G Hoctor, Ryan E Longman, J Sudharma Ranasinghe
Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents...
August 2016: Anesthesia and Analgesia
Daniel Ruiz-Pérez, Carlota Largo, Francisco García-Río
In recent years, the number of lung transplantations performed as the last option for many respiratory diseases has grown considerably, both in adults and children. However, the causes for the relatively short survival of lungs compared to other organ transplants still need to be studied. Techniques have improved since the 1950s when experimental lung transplantation began, and the different animal species used now include rodents. The advantage of using these small species is that the surgical model has been expanded and standardized, and different respiratory problems can be studied...
May 31, 2016: Archivos de Bronconeumología
Travis Schisler, Jose M Marquez, Ibtesam Hilmi, Kathirvel Subramaniam
Anesthesia for lung transplantation remains one of the highest risk surgeries in the domain of the cardiothoracic anesthesiologist. End-stage lung disease, pulmonary hypertension, and right heart dysfunction as well as other comorbid disease factors predispose the patient to cardiovascular, respiratory and metabolic dysfunction during general anesthesia. Perhaps the highest risk phase of surgery in the patient with severe pulmonary hypertension is during the induction of anesthesia when the removal of intrinsic sympathetic tone and onset of positive pressure ventilation can decompensate a severely compromised cardiovascular system...
June 1, 2016: Seminars in Cardiothoracic and Vascular Anesthesia
Sandeep Chauhan, Kamal P Sharma, Akshay K Bisoi, Raju Pangeni, Karan Madan, Yogendra S Chauhan
Pulmonary alveolar proteinosis (PAP) is a rare lung disease characterized by accumulation of excessive lung surfactant in the alveoli leading to restrictive lung functions and impaired gas exchange. Whole lung lavage (WLL) is the treatment modality of choice, which is usually performed using double lumen endobronchial tube insertion under general anesthesia and alternating unilateral lung ventilation and washing with normal saline. It may be difficult to perform WLL in patients with severe hypoxemia wherein patients do not tolerate single lung ventilation...
April 2016: Annals of Cardiac Anaesthesia
Tülin Akarsu Ayazoğlu, Aynur Ozensoy, Mehmet Dedemoğlu, Ayse Baysal, Yasar G Gul, Didem Onk, Alper Onk
AIM: The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases. METHODS: From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0...
April 2016: Archives of Iranian Medicine
Maria Teresa Rincón Vieira Lugarinho-Monteiro, Luciane Pereira, Carlos Seco
BACKGROUND: Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. CASE REPORT: We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia, resulting from a car accident when she was 8 years old...
March 19, 2016: Revista Brasileira de Anestesiologia
Danton S Char, Vamsi Yarlagadda, Katsuhide Maeda, Glyn Williams
Pediatric patients with end-stage respiratory failure and pulmonary hypertension traditionally have poor outcomes when bridged with extracorporeal membrane oxygenation to lung or heart-lung transplantation. Therefore, several institutions have attempted paracorporeal lung assist devices as a bridge. However, given the small number of patients, little is known about approaches to anesthetic induction in these hemodynamically unstable patients either before placement of a device or anesthetic induction once a device is in situ...
May 15, 2016: A & A Case Reports
Thomas Fuehner, Jan Fuge, Meike Jungen, Anna Buck, Hendrik Suhling, Tobias Welte, Jens Gottlieb, Mark Greer
INTRODUCTION: Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients. METHODS: Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA)...
2016: PloS One
Zirka H Anastasian, Minjae Kim, Eric J Heyer, Shuang Wang, Mitchell F Berman
BACKGROUND: Factors including ASA physical status, blood loss, and case length have been described as correlating with the decision to delay tracheal extubation after specific surgical procedures. In this retrospective study, we investigated whether handoffs by anesthesia attendings were associated with delayed extubation after general anesthesia for a broad range of surgical procedures. METHODS: We reviewed the records of 37,824 patients who underwent general anesthesia with an endotracheal tube for surgery (excluding tracheostomy surgery, cardiac surgeries, and liver and lung transplant surgeries) from 2008 to 2013 at Columbia University Medical Center...
March 2016: Anesthesia and Analgesia
Ashley Eggers, Gregory J Latham, Jeremy Geiduschek, Delphine Yung, Jonathan M Chen, Denise C Joffe
Childhood idiopathic pulmonary arterial hypertension is a progressive and fatal disease. When pulmonary artery pressures become suprasystemic and refractory to medical management, atrial septostomy can be recommended for bridging patients to lung transplantation. Recently, a surgical Potts shunt has been recommended as an alternative rescue therapy, and initial outcome data are promising. The placement of a Potts shunt converts the child to Eisenmenger physiology, which is anticipated to provide an improved quality and duration of life...
February 1, 2016: A & A Case Reports
Dominik J Hoechter, Vera von Dossow
PURPOSE OF REVIEW: The perioperative management of lung transplantation patients remains a challenge. The most important goal is the prevention or attenuation of primary graft failure due to ischemia and reperfusion, operative trauma, and activation of systemic inflammation; it significantly influences short-long and long-term outcome. This review focuses on different aspects regarding the management of these high-risk patients. RECENT FINDINGS: The Lung Allocation Score was implemented to estimate the survival benefit from a lung transplant...
February 2016: Current Opinion in Anaesthesiology
Nao Tateura, Hiromi Sato, Takero Arai, Takashi Asai, Yasuhisa Okuda
A 54-year-old man with lung cancer was scheduled for thoracoscopic upper lobe resection under general anesthesia. About half a year previously, he had undergone surgery for oropharyngeal cancer and tongue cancer. As a result of the surgery, elasticity of the neck skin bending of the neck were restricted (Mallampati classification IV). A narrow-bored tracheostomy tube (speech cannula) was inserted. In the operating room, the tip of a 5.0 mm ID standard tube was inserted from the tracheostomy tube, and connected to a breathing circuit...
August 2015: Masui. the Japanese Journal of Anesthesiology
Takuji Suzuki
Hereditary pulmonary alveolar proteinosis (hPAP) is characterized by pulmonary surfactant accumulation and respiratory failure due to defective GM-CSF receptor signaling caused by recessive genetic mutations in genes encoding the GM-CSF receptor (CSF2RA or CSF2RB), which impairs multiple alveolar macrophage (AM) functions including pulmonary surfactant clearance. An identical disease occurs in Csf2rb-/- (KO) mice. Whole lung lavage under general anesthesia is the only available therapy and is required in some patients every several months...
2015: Keio Journal of Medicine
Ignacio Garutti, Javier Sanz, Luis Olmedilla, Itziar Tranche, Almudena Vilchez, Lorenzo Fernandez-Quero, Rafael Bañares, Jose María Perez-Peña
BACKGROUND: Pulmonary edema (PE) after orthotopic liver transplantation (OLT) may compromise the postoperative course and prolong the duration of mechanical ventilation (MV) and intensive care unit length of stay. Hemodynamic monitoring with transpulmonary thermodilution permits quantification of extravascular lung water index (ELWI) and calculation of the pulmonary vascular permeability index (PVPI), which is the ratio between the ELWI and the pulmonary blood volume. This ratio can discriminate between PE hydrostatic and nonhydrostatic PE...
September 2015: Anesthesia and Analgesia
Hiroaki Toyama, Kazutomo Saitoh, Yusuke Takei, Yutaka Ejima, Shin Kurosawa, Masanori Yamauchi
We report on two patients who underwent bilateral lung transplantation (BLTx) combined with cardiac surgery. Patient 1 was a female whose pulmonary hypertension resulted from a congenital atrial septal defect (ASD) and idiopathic pulmonary arterial hypertension. She had a very small left ventricle (LV). We initiated venoarterial extracorporeal membrane oxygenation (ECMO) before induction of general anesthesia. She underwent ASD patch closure, pulmonary artery replacement, and BLTx under cardiopulmonary bypass (CPB)...
December 2015: Journal of Anesthesia
Xinjin Chi, Xiaoxia Wei, Wanling Gao, Jianqiang Guan, Xiaofan Yu, Yiheng Wang, Xi Li, Jun Cai
BACKGROUND: To investigate whether pretreatment with dexmedetomidine (Dex) has a protective effect against acute lung injury (ALI) in an orthotopic autologous liver transplantation (OALT) rat model and to explore the mechanisms responsible for the protective effect of Dex against lung injury. METHODS: Forty-eight rats underwent OALT and were randomly divided into six groups (n = 8 in each group) that received 10 µg/kg Dex, 50 µg/kg Dex, 50 µg/kg Dex + nonspecific α2-adrenergic receptor (AR) antagonist atipamezole, 50 µg/kg Dex + specific α2B/C-AR antagonist ARC-239, 50 µg/kg Dex + specific α2A-AR antagonist BRL-44408, or the same amount of normal saline...
2015: Journal of Translational Medicine
Carlos Galvez, Sergio Bolufer, Jose Navarro-Martinez, Francisco Lirio, Juan Manuel Corcoles, Jose Manuel Rodriguez-Paniagua
Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent...
May 2015: Annals of Translational Medicine
Javier E Anaya-Ayala, Matthias Loebe, Mark G Davies
PURPOSE: To report the safety and short-term efficacy of endovascular interventions for symptomatic lung transplant-related anastomotic pulmonary artery stenosis (PAS). MATERIALS AND METHODS: From February 2008 to December 2011, 354 lung transplants were performed. Pulmonary arteriography was performed in 19 patients (63% men; age, 57 y ± 21, mean ± SD; seven double-lung transplants) because of respiratory decompensation (mean 6.7 mo after transplant). Seven arteriograms were normal, and 12 showed significant PAS...
June 2015: Journal of Vascular and Interventional Radiology: JVIR
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