Anesthesia and Hemodynamic Management for Lung Transplantation
This chapter discusses the key preoperative considerations, intraoperative management strategies for lung transplantation as it pertains to induction of anesthesia, airway management, hemodynamic management, and postoperative analgesic strategies, with a review of the evidence. If a patient is deemed a candidate for lung transplantation, they are assigned a lung allocation score which determines their position on the waitlist. Patients undergo comprehensive imaging and laboratory testing prior to being listed. The cardiovascular status of the patient, particularly reduced cardiac index and increased pulmonary artery pressures, help define the urgency of transplantation and may predict hemodynamic instability and necessity for mechanical circulatory support. Maintaining hemodynamic stability on induction is the goal for all surgical procedures; however, this goal may be particularly challenging to achieve in the end-stage lung disease patient population. Maintenance of general anesthesia during lung transplantation can be achieved with inhaled volatile anesthetics or with total intravenous anesthesia, or a combination of both.
