Anesthesia for Thoracic Surgery - Lung Transplantation
Lung transplantation is performed for end-stage nonmalignant lung disease. The most common indications are severe emphysema, α1-antitrypsin deficiency, cystic fibrosis, pulmonary fibrosis, and pulmonary hypertension. Specific operations include living-related lobar lung transplant (LRLLTx), single-lung transplant (SLTx), double-lung transplant (DLTx), sequential SLTx, and combined heart–lung transplantation. The etiology of the lung disease usually dictates the specific operation to be performed and the likelihood that CPB will be required. Furthermore, the patient's position depends on the incision required for adequate surgical exposure (lateral decub/thoracotomy for SLTx and clamshell incision/supine for DLTx or LRLLTx). Hence, knowing the patient's preoperative diagnosis will suggest the required approach. Patients will have undergone preoperative counseling, exercise and cardiac testing, and a conditioning program along with other assessments outlined in section I. Because the optimal donor ischemic time is less than 4 hours, time is of the essence.
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