Anesthetic management for lung transplantation

For end-stage lung disease refractory to medical management, lung transplantation remains the definitive treatment. However, this procedure presents unique challenges for the anesthesiologist. This review summarizes the recent literature regarding this procedure and its anesthetic management.

Changes in the lung allocation system have had an impact on the characteristics of patients presenting for lung transplantation, resulting in patients who are older, sicker, and possibly presenting for retransplantation. In addition, various donor and recipient characteristics, including BMI, race, sex, and comorbidities such as diabetes and atrial fibrillation, have been shown to influence outcomes. Perioperative management, particularly colloid administration, adequate pain control, and treatment of pulmonary hypertension, may also affect outcomes.

Careful preoperative assessment of pulmonary and cardiac function and comorbidities are particularly important for this patient population. Lung protective strategies, intra-operative transesophageal echocardiogram, pulmonary artery catheterization, cardiopulmonary bypass, inhaled nitric oxide, and inhaled prostacyclin are all important tools for the anesthesiologist to optimize patient care.