Isolated lung transplantation: a review of problems and guide to anaesthesia

Some recipients of isolated, orthotopic lung transplants have now survived to leave hospital with greatly improved quality of life. Inevitably, the successful demonstration of the feasibility of these operations means that transplant centres throughout the world may wish to participate in a lung transplant programme. The indications and preparations for, and some of the implications of, these operations are discussed and some of the relevant literature, pertaining to perioperative anaesthetic management, reviewed. Successful transplantation has vindicated the policy that anaesthesia for these patients can be managed with methods conventional for pulmonary resection, and without resort to cardiopulmonary bypass. Key operative points highlighted, and management factors, based on practical experience, are suggested to provide guidelines for the benefit of those anaesthetists who may be involved in lung transplantation.