Anaes · Thoracic anaesthesia
Anaesthesia for lung transplantation
Also known as Bilateral sequential lung transplant anaesthesia · Primary graft dysfunction PGD · LTx ECMO anaesthesia
Exam-pass lung transplant anaesthesia: end-stage lung disease physiology, induction risks, PA clamping and reperfusion, ECMO/CPB triggers, primary graft dysfunction, and ICU ventilation strategies.
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Red flags
- Induction in severe PHT/RV failure can cause arrest — plan ECMO/CPB rescue.
- PA clamp tests RV afterload suddenly.
- Reperfusion can cause severe graft pulmonary oedema/PGD.
- Fluid overload worsens graft function.
- Airway anastomosis and native lung issues in single LTx.
Meet the patient
A 55-year-old with idiopathic pulmonary fibrosis and pulmonary hypertension arrives for a bilateral sequential lung transplant. Her right ventricle is thick, strained, and one bad induction away from arrest. The circuit team is in the room before the drugs are drawn.[1]
Two questions frame the topic: how do I get her through induction without killing the right ventricle? (titrated induction, pulmonary vasodilators, vasopressor and inotrope readiness, ECMO or CPB primed), and how do I protect the new lung when it reperfuses? (gentle pressures, protective ventilation, fluid discipline, PGD watch). Phase-based answers win; organ lists without phases fail.[1]
References3ShowHide
- [1]Marczin N, de Waal EEC, Hopkins PMA, et al. International consensus recommendations for anesthetic and intensive care management of lung transplantation. An EACTAIC, SCA, ISHLT, ESOT, ESTS, and AST approved document J Heart Lung Transplant, 2021.PMID 34732281
- [2]Kim HJ, Shin SW, et al. A Review of Anesthesia for Lung Transplantation J Chest Surg, 2022.PMID 35924536
- [3]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery N Engl J Med, 2017.PMID 29130845