Abstract
Anesthesia was done for 36 patients undergoing orthotropic heart transplantation in Beijing Anzhen Hospital from April 2015 to November 2016.Anesthesia management for orthotropic heart transplantation and related problems were analyzed and investigated.Anesthesia management protocol for patients with end-stage heart disease was aimed at reducing fluctuation of hemodynamics and avoiding malignant arrhythmia.Anesthesia was induced by intravenously injecting diazepam 5-10 mg, etomidate 0.2-0.3 mg/kg or ketamine 1 mg/kg, sufentanil 1.0-1.5 μg/kg or fentanyl 10-15 μg/kg and rocuronium 0.6 mg/kg.Anesthesia was maintained by continuously infusing dexmedetomidine 0.3-0.5 μg·kg-1·h-1, cisatracurium 10 mg/h and sufentanil 0.5-1.0 μg·kg-1·h-1.Pulmonary arterial pressure and donor heart function were monitored using the flow-directed pulmonary artery catheter.Dopamine, epinephrine and isoprenaline were intravenously infused after cardiopulmonary bypass to maintain circulation stable.Nitroglycerin and prostacyclin were intravenously infused to decrease pulmonary arterial pressure.Immunosuppressive therapy was performed with methylprednisone, mycophenolate mofetil and cyclosporine/FK506.Thirty-two patients were discharged from hospital, and 4 cases died.Among the 4 patients died, 1 patient died of pulmonary hypertension (pulmonary arterial systolic pressure>67 mmHg) and right heart failure and, 1 patient showed difficulty in weaning from cardiopulmonary bypass and 2 patients died of refractory low cardiac output and multi-organ failure.Anesthetic management for heart transplantation required an appreciation of the pathophysiological mechanism of heart failure.Invasive monitoring, steady anesthesia induction and maintenance, stable hemodynamics in the perioperative period and good donor heart protection were the keys to ensuring anesthesia management for orthotropic heart transplantation. Key words: Heart transplantation; Anesthesia; Retrospective studies
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