Anaesthesia for noncardiac surgery in the heart transplant recipient

Anaesthetizing a patient who benefited from a heart transplant will undoubtedly fascinate any anaesthetist. Basic principles need to be adhered to in order to ensure that no unnecessary harm is caused to these patients. Furthermore, the conscientious anaesthetist will want to remain abreast of the advances in the understanding of physiological changes occurring over the years after transplantation and the continuous innovations in the field of immunosuppression.

Understanding of the mechanisms surrounding cardiac allograft vasculopathy and insight into the possibility of reinnervation are continuously evolving; but changes in therapeutic regimens in an attempt to lower side effects have probably a greater impact on day-to-day clinical practice.

Understanding how to administer fluids adequately to a transplant patient; how to use direct vasoactive agents; how to manage the infectious risk; and the need to be aware of the multiple side effects of immunosuppressive regimens are essential to recognize, prevent or treat possible perioperative complications.