Anesthetic Challenges in Patients After Lung Transplantation

Abstract

Introduction: Recipients of lung transplants have subsequently undergone various surgical procedures unrelated to their pulmonary disease and may have anesthetic problems. Case presentation: Fifty-nine-year-old male, status post single lung transplant due to pulmonary fibrosis. He presented for laparotomy due to ischemic colitis. Induction of general anesthesia was rapid sequence. Invasive monitoring was inserted in the radial artery and internal jugular vein. Ventilation was with pressure controlled mode.Discussion: The administration of general anesthesia to patients after lung transplantation will be influenced by the degree of dysfunction exhibited by the transplanted lung, as well as the remaining native lung. The loss of afferent and efferent innervation distal to the bronchial anastomosis results in the loss of the cough reflex and neurally mediated changes in airway bronchomotor tone. The basic goal of ventilation is to ensure adequate oxygenation and ventilation while minimizing peak airway pressures. Pressure-cycled ventilation is the preferred method.