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Lung transplantation requires cardiac anesthesia techniques including one-lung ventilation and potentially cardiopulmonary bypass. Careful donor and recipient evaluation is important. Management of hemodynamics and ventilation are key, given underlying cardiopulmonary issues in these patients. A multidisciplinary team approach is needed for this complex procedure.
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This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
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2) PE is classified by size from massive to small, with massive PE affecting half the pulmonary arteries and causing shock while small PE causes few symptoms.
3) Diagnosis involves assessment of clinical probability with tools like Wells Criteria followed by tests like CT, ventilation-perfusion scan, or ultrasound depending on the patient's situation.
4) Treatment involves anticoagulation with drugs like heparin or novel oral anticoagulants, with duration depending on prov
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This document summarizes adult congenital heart disease and considerations for anesthesia management. It discusses that:
1) Congenital heart diseases are increasingly common as more children with complex defects now survive into adulthood.
2) Adults with CHD can be categorized as those with complete repair, partial/palliative repair, or no operation.
3) Five factors influence perioperative risk - pulmonary hypertension, cyanosis, reoperation, arrhythmias, and ventricular dysfunction.
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1) Massive pulmonary embolism (PE) occurs when over 50% of the pulmonary artery is blocked, causing low blood pressure. It can rapidly lead to death if not treated.
2) Initial treatment includes oxygen, intravenous fluids, medications to support blood pressure, and potentially thrombolytics to dissolve clots. Thrombolytics may improve heart and lung function temporarily but do not reliably reduce mortality.
3) For patients who cannot receive thrombolytics or if thrombolytics fail, emergency surgical removal of clots or catheter-based clot removal may be considered to prevent death from massive PE. Outcomes vary but can be lifesaving in some cases.
Computed Tomography Angiography in Chronic Pulmonary Thromboembolism
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
Massive pulmonary embolism case presentation
A 35-year-old woman presented with sudden collapse and was found to have signs of pulmonary embolism including decreased oxygen levels and an enlarged right ventricle on echocardiogram. She received thrombolysis with alteplase and showed immediate improvement. Echocardiography is useful for evaluating suspected pulmonary embolism cases with hemodynamic instability or where other imaging is not available by showing signs like right ventricle enlargement or strain, though the findings are not specific. Thrombolysis has been shown to be more effective than other treatments for massive pulmonary embolism cases.
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2. The main anesthetic goal is to maintain renal perfusion and prevent hypotension, hypovolemia and hypoxia which could further compromise renal function.
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Digital subtraction pulmonary angiography (DSPA) is the definitive test for evaluating diseases of the pulmonary vasculature like pulmonary embolism. It allows visualization of all pulmonary arterial branches and therapeutic interventions. DSPA involves percutaneous venous catheterization and injection of iodinated contrast agents to produce images of the pulmonary arteries and veins. While it remains the criterion standard, DSPA has risks like acute cor pulmonale in patients with pulmonary hypertension and operator dependency remains a concern due to potential 10-15% interobserver variability in examining small vessels.
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This document discusses surgical options for single ventricle heart defects, including the indications, timing, and outcomes of various palliative surgeries. It describes initial procedures like pulmonary artery banding or shunting to relieve obstruction and provide pulmonary blood flow. It then discusses staged repairs like the bidirectional Glenn procedure or hemi-Fontan that redirect blood flow. Finally, it covers the modified Fontan operation, which separates systemic and pulmonary circulation without a subpulmonary ventricle. Complications, long-term outcomes, and factors affecting success are also addressed.
Rvmi.+ case
1. An 86-year-old female patient presented with chest pain, difficulty breathing, and general weakness. ECG results at the ambulance and hospital pointed to a diagnosis of posterior inferior myocardial infarction involving both the left and right ventricles.
2. She had multiple risk factors for heart disease including longstanding hypertension, diabetes, and atherosclerosis.
3. Intensive treatment in the ICU focused on fluid resuscitation, inotropes, and medications to stabilize her hemodynamics and support organ function as she presented with cardiogenic shock on admission.
Platypnoea orthopnoea syndrome
Platypnoea Orthodeoxia Syndrome (POS) involves worsening of shortness of breath and oxygen levels when moving from a lying to standing position. It is caused by an intra-cardiac shunt like a patent foramen ovale or intrapulmonary shunting from conditions like liver disease. Diagnosis involves testing oxygen levels and imaging the heart and lungs in both positions. Treatment depends on the underlying cause but may involve closing cardiac defects surgically or addressing lung conditions medically.
EISENMENGER SYNDROME- PAUL WOOD
This document discusses Eisenmenger syndrome, a condition where pulmonary hypertension develops due to increased blood flow through defects between the systemic and pulmonary circulations. It provides details on causes, clinical features, pathology findings, and treatments. Key points include:
- Eisenmenger syndrome is caused by defects like VSDs, ASDs, and PDA that allow high blood flow to the lungs and cause pulmonary hypertension over time.
- Common causes of death include hemoptysis from pulmonary artery ruptures, heart failure, and complications from attempted defect repair surgery.
- Pathological findings show thickened pulmonary arteries that resemble the fetal pattern and contribute to high pulmonary vascular resistance.
- Medical treatments are generally ineffective once int
pulmonary embolism
1) Pulmonary embolism (PE) was first described in the 18th century and risk factors include both modifiable factors like obesity and smoking as well as non-modifiable factors like age, family history, and cancer.
2) PE is classified by size from massive to small, with massive PE affecting half the pulmonary arteries and causing shock while small PE causes few symptoms.
3) Diagnosis involves assessment of clinical probability with tools like Wells Criteria followed by tests like CT, ventilation-perfusion scan, or ultrasound depending on the patient's situation.
4) Treatment involves anticoagulation with drugs like heparin or novel oral anticoagulants, with duration depending on prov
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This document summarizes adult congenital heart disease and considerations for anesthesia management. It discusses that:
1) Congenital heart diseases are increasingly common as more children with complex defects now survive into adulthood.
2) Adults with CHD can be categorized as those with complete repair, partial/palliative repair, or no operation.
3) Five factors influence perioperative risk - pulmonary hypertension, cyanosis, reoperation, arrhythmias, and ventricular dysfunction.
Acute pulmonary embolism case based
1) Massive pulmonary embolism (PE) occurs when over 50% of the pulmonary artery is blocked, causing low blood pressure. It can rapidly lead to death if not treated.
2) Initial treatment includes oxygen, intravenous fluids, medications to support blood pressure, and potentially thrombolytics to dissolve clots. Thrombolytics may improve heart and lung function temporarily but do not reliably reduce mortality.
3) For patients who cannot receive thrombolytics or if thrombolytics fail, emergency surgical removal of clots or catheter-based clot removal may be considered to prevent death from massive PE. Outcomes vary but can be lifesaving in some cases.
Computed Tomography Angiography in Chronic Pulmonary Thromboembolism
Chronic thromboembolic pulmonary hypertension is clearly more common than previously was thought, and misdiagnosis is common because patients often present with nonspecific symptoms related to pulmonary hypertension. Computed tomography (CT) is a useful alternative to conventional angiography not only for diagnosing chronic pulmonary thromboembolism but also for determining which cases are treatable with surgery and confirming technical success postoperatively. Early recognition of chronic pulmonary thromboembolism may help improve the outcome, since the condition is potentially curable with pulmonary thromboendarterectomy.
Massive pulmonary embolism case presentation
A 35-year-old woman presented with sudden collapse and was found to have signs of pulmonary embolism including decreased oxygen levels and an enlarged right ventricle on echocardiogram. She received thrombolysis with alteplase and showed immediate improvement. Echocardiography is useful for evaluating suspected pulmonary embolism cases with hemodynamic instability or where other imaging is not available by showing signs like right ventricle enlargement or strain, though the findings are not specific. Thrombolysis has been shown to be more effective than other treatments for massive pulmonary embolism cases.
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1. Renal transplant patients have altered physiology due to immunosuppression and the transplanted organ. Their renal function is usually reduced which can impact drug metabolism and excretion.
2. The main anesthetic goal is to maintain renal perfusion and prevent hypotension, hypovolemia and hypoxia which could further compromise renal function.
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1) It is an inherited disease that affects the lungs and digestive system of about 1,200 people in Ireland.
2) The pathophysiology involves mutations in the CFTR gene resulting in thick, sticky secretions in organs like the lungs and pancreas.
3) Treatment aims to minimize infections, optimize nutrition, and slow disease progression through therapies like airway clearance and antibiotics. For advanced disease, lung transplantation may be an option.
One Lung Ventilation
During one lung ventilation (OLV), blood flow is shunted to the non-ventilated lung causing hypoxemia. Anesthetics mildly inhibit hypoxic pulmonary vasoconstriction (HPV), increasing shunt by around 4%. Positioning and techniques like selective lung ventilation and PEEP can optimize ventilation and perfusion matching to minimize hypoxemia during OLV.
Lung Transplantation
This document discusses lung transplantation, including indications, contraindications, procedures, management, and follow up. It provides details on types of lung transplants including single lung, double lung, and living donor lobar lung transplantation. Requirements for donors and recipients are outlined. The document also discusses lung transplantation practices and outcomes in Saudi Arabia, noting that the first program began in 2003 and has performed over 70 transplants, limited by lack of organ donors.
Lung transplantation
Lung transplantation involves removing one or both diseased lungs and replacing them with healthy donor lungs. It is used to treat end-stage lung diseases that are unresponsive to other therapies. The first successful lung transplant was performed in 1963, though early recipients only survived briefly. Advances since then have improved outcomes. Lung transplantation may involve single, double, or heart-lung transplants depending on the condition. Selection criteria evaluate patients' medical status and potential for rehabilitation. Careful donor screening and organ preservation are important for success. Post-operative care focuses on monitoring for complications like infection, acute rejection, and bronchiolitis obliterans syndrome.
Anaesthetic consideration for one lung ventilation
PRESENTATION , WHICH MAY HELP REVISING IMPORTANT FACTS IN CLINICAL PRACTICE.
INCLUDING NEEDS , COMPLICATION, EXPERTISE.
Anesthesia for Liver transplantation - Dr.Sandeep
Liver transplantation is a complex procedure that requires careful anaesthetic management due to the pathophysiological changes associated with end-stage liver disease. Key considerations include monitoring for haemodynamic instability, coagulopathy and metabolic disturbances. Frequent intraoperative monitoring and correction of abnormalities are important to assess graft function and optimize patient outcomes.
Organ transplantation heart & lung transplant
Power point presentation about general principles of organ transplantation and pioneer surgons and investigators, Specific discussion about Heart, Heart lung and Lung transplantation is given
Organ transplant ppt
Background of organ transplant infrastructure in the US. Some history. Definitions. Nursing Care of the transplant patient in hospital, and home settings. Intended for senior level nursing students in an ADN program
Organ transplantation ppt
This document provides an overview of organ transplantation. It defines organ transplantation and lists the major organs and tissues that can be transplanted. It discusses the different types of transplants including autografts, allografts, isografts, xenografts, split transplants, and domino transplants. It also outlines the history and timeline of important transplant milestones and provides details on transplant rejection, immunosuppressive drugs, costs, and conclusions.
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Lung Transplantation - Where we are and Where we are going
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Anaesthetic consideration for one lung ventilation
Anaesthetic consideration for one lung ventilation
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ECMO in Cardiac Arrest
ECMO is a form of extracorporeal life support that oxygenates and removes carbon dioxide from the blood. It is being considered in the emergency department for patients experiencing refractory ventricular fibrillation during cardiac arrest. ECMO may improve survival rates and neurological outcomes compared to conventional CPR. There are indications and contraindications for its use in acute, severe reversible respiratory or cardiac failure. The two main types are veno-venous ECMO for respiratory failure and veno-arterial ECMO for cardiac failure. Proper patient selection, cannulation technique, and circuit management are important considerations for ECMO in cardiac arrest.
ECMO Basics.pptx
ECMO is a form of extracorporeal life support used for patients with severe cardiac or respiratory failure. It works by removing blood from the body, oxygenating it, and returning it. The document discusses the history and development of ECMO, components of the ECMO circuit, modes of ECMO including veno-venous and veno-arterial, indications and contraindications for its use, complications, and criteria for weaning patients off of ECMO support.
ipertensione polmonare postembolica-cteph
This document discusses the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) including:
1) CTEPH was historically treated with lung transplantation but can now often be treated with pulmonary endarterectomy (PEA) surgery without transplantation.
2) The document outlines patient selection criteria for PEA versus transplantation based on clinical factors like age and hemodynamics as well as anatomical factors regarding lesion location.
3) It provides an overview of one center's experience performing over 350 PEAs for CTEPH patients.
ECMO.pptx
This document discusses extracorporeal membrane oxygenation (ECMO), including its indications, types (veno-arterial and veno-venous), management strategies, and the experience with ECMO at Heart Hospital. ECMO can be used as a bridge to recovery, decision-making, surgery, long-term devices like LVADs, or transplant. It involves draining blood from the body, removing carbon dioxide and adding oxygen through an external oxygenator before returning the blood. Management involves anticoagulation and monitoring various patient parameters. Complications can include bleeding, infection, and organ dysfunction. Criteria and protocols are discussed for weaning patients off ECMO support.
Cardiac single ventricle
The document discusses the single ventricle condition known as hypoplastic left heart syndrome (HLHS). It covers the embryology, anatomy, physiology, treatment options and stages of palliation including the Norwood procedure (Stage I), Glenn or Hemi-Fontan procedure (Stage II), and Fontan procedure (Stage III). The goal of staged surgical repairs is to gradually unload the single ventricle and optimize pulmonary and systemic blood flow to allow for growth prior to the final Fontan circulation.
Critical care
This document provides an overview of critical care topics including patients requiring intensive care unit (ITU) care for conditions like multiple trauma, severe sepsis, and postoperative complications. It discusses indications for ICU transfer if a patient has actual or potential organ failure. Tools for critical care monitoring of respiratory and cardiovascular systems are outlined, including pulse oximetry, capnography, arterial lines, and pulmonary artery catheters. Common postoperative issues like pulmonary collapse and hypotension are described with their presentations and management approaches.
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Ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction (MI).
Bimodal peak
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Average time to rupture
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Management of Congestive Heart Failure: An Approach for the New Millenium (19...
This document discusses congestive heart failure (CHF), pulmonary edema, and the use of CPAP to treat patients experiencing acute pulmonary edema due to CHF. It provides an overview of cardiac physiology and the pathophysiology of CHF. CPAP is presented as a non-invasive treatment that can open collapsed airways and reduce work of breathing. Guidelines are given for appropriate prehospital patients and how to apply and monitor CPAP. Studies show CPAP can improve respiratory status and reduce intubation rates, ICU admissions, and hospital stays compared to traditional oxygen therapy alone.
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This document discusses cyanosis and its causes in neonates. It begins by defining cyanosis as a bluish tinge of the skin and mucous membranes, detectable when hemoglobin is reduced by more than 5g% or oxygen saturation is below 85%. It then lists various pulmonary, cardiac, central nervous system, metabolic, hematologic, and infectious conditions that can cause cyanosis in newborns. The majority of the document focuses on describing tetralogy of Fallot, including its characteristic features, pathophysiology, clinical presentation, diagnosis, and management. It provides details on the anatomy, causes, hypoxic spells, and treatment approaches for tetralogy of Fallot.
anaesthesia in laparoscopic surgery
Laparoscopic surgery involves insufflating the abdominal cavity with gas to provide space for visualization and instruments. Anesthesia aims to minimize the cardiovascular and respiratory effects of pneumoperitoneum and positioning. General anesthesia is most common to protect the airway and control gas flow. Care is taken with patient positioning, gas selection, and addressing risks like gas embolism, pneumothorax, or nerve injury. Special considerations exist for laparoscopy in children, pregnancy, and gasless techniques.
Trauma & Burns
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- Patients undergoing vascular surgery often have multiple comorbidities like coronary artery disease, hypertension, diabetes, and impaired cardiac function, placing them at high risk for perioperative complications. Careful monitoring and management of cardiovascular status is important during and after the procedures.
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Anes Vascular
This document discusses several topics related to vascular surgery:
1) Aorto-occlusive disease causes inadequate blood flow to organs and extremities. Myocardial dysfunction is a major cause of morbidity after vascular surgery.
2) Patients undergoing procedures like abdominal aortic aneurysm repair are at high risk of cardiac complications due to comorbidities like heart disease.
3) Carotid endarterectomy requires careful management to balance cerebral perfusion and cardiac stress during surgery.
CTEPH, Surgcal and Medical Therapy. Terapia Chirurgica e medica
This document summarizes the experience of pulmonary endarterectomy (PEA) at a hospital in Pavia, Italy. It describes that PEA is the primary treatment for chronic thromboembolic pulmonary hypertension (CTEPH), and has better long-term outcomes than lung transplantation. The Pavia center has performed over 357 PEAs since 1994 and has developed expertise in evaluating, diagnosing, and performing the surgery on CTEPH patients.
CTEPH, Surgical and Medical Therapy. CTEPH, Terapia Chirurgica e Medica
This document summarizes the experience of pulmonary endarterectomy (PEA) at a hospital in Pavia, Italy. It describes that PEA is the primary treatment for chronic thromboembolic pulmonary hypertension (CTEPH), which can be surgically treated to remove blockages in the pulmonary arteries. The hospital has performed over 357 PEAs and seen good outcomes with low mortality and technical failure rates when performed by experienced surgeons.
Anaesthesia For Laparoscopic Assisted Surgery Dr. Shailendra
This document discusses anesthesia management for laparoscopic assisted surgery. Some key points include:
- Laparoscopy has advantages over open surgery like shorter hospital stays and faster recovery, but can pose respiratory and cardiovascular risks under anesthesia.
- Maintaining adequate ventilation and oxygenation can be challenging due to absorption of carbon dioxide and positioning effects.
- Gas embolism is a serious risk if gas is directly injected into blood vessels, which can cause hypotension, arrhythmias and death if massive.
- Patient positioning like head-down can increase risks like elevated intracranial pressure and decreased cardiac output that anesthesiologists must manage closely.
Cardiogenic shock
The document discusses cardiogenic shock, which occurs in 5-8% of patients hospitalized with ST elevation myocardial infarction (STEMI). It describes the pathophysiology, criteria for diagnosis, causes, clinical presentation, investigations including echocardiography and pulmonary artery catheterization, management with inotropes, vasopressors, IABP, and early revascularization, as well as prognosis. Early revascularization via PCI or CABG within 18 hours of shock improves survival substantially. Newer mechanical support devices such as percutaneous LVADs are promising but limited by complications. Most hospital survivors have excellent long term survival and quality of life.
Pulmonary Embolism and CTEPH
PE between reality and future
All about PE from risk stratification to diagnosis and treatment with different modalities & going through CTEPH too
Laparoscopy in COPD: Anaesthesia
Anesthetic management of a patient with COPD posted for Laparoscopic Cholecystectomy - Case discussion
Laparoscopy in COPD: Anaesthesia
Anesthetic management of a patient with COPD posted for Laparoscopic Cholecystectomy - case discussion
Criticaal care
This document discusses various methods of monitoring surgical patients, including arterial catheterization to monitor blood pressure, central venous catheterization to monitor central venous pressure, and pulmonary artery catheterization to obtain hemodynamic parameters. It describes the indications, sites, measurements, and potential complications of each method. Neurologic monitoring techniques are also outlined, such as intracranial pressure monitoring, electroencephalography, transcranial Doppler ultrasonography, and jugular venous oximetry.
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Management of Congestive Heart Failure: An Approach for the New Millenium (19...
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CTEPH, Surgcal and Medical Therapy. Terapia Chirurgica e medica
CTEPH, Surgcal and Medical Therapy. Terapia Chirurgica e medica
CTEPH, Surgical and Medical Therapy. CTEPH, Terapia Chirurgica e Medica
CTEPH, Surgical and Medical Therapy. CTEPH, Terapia Chirurgica e Medica
Anaesthesia For Laparoscopic Assisted Surgery Dr. Shailendra
Anaesthesia For Laparoscopic Assisted Surgery Dr. Shailendra
FAST PPT
- 1. ANESTHESIA CONSIDERATIONS FOR LUNG TRANSPLANT DR. ABHIJIT S. NAIR Consultant Anesthesiologist
- 2. Is anesthesia management related to cardiac anesthesia or OLV as in non cardiac thoracic surgeries?
- 3. “ ITS CARDIAC ANESTHESIA WITH OLV ( DLT OR BLOCKER) EITHER BEATING HEART OR CPB WITHOUT CARDIOPLEGIA ”
- 4. DONORS Brain dead/ trauma victims Compatible P/F ratio > 300 Less than 60 years Preferably non- smokers Acceptable bronchoscopy findings
- 5. INDICATIONS “ End stage lung disease “ Suppurative Restrictive Obstructive Pulmonary vascular
- 6. SINGLE LUNG TRANSPLANT Emphysema Pulmonary fibrosis Pulmonary Hypertension Connective tissue disorders ILD Bronchoalveolar carcinoma?
- 7. DOUBLE LUNG TRANSPLANT Suppurative lung disease Emphysema PH
- 8. ABSOLUTE CONTRAINDICATIONS Ventilatory cripple Metastatic cancer Serious, multiple co-morbidities Psychosocial issues Serious chest wall deformity Viral markers positive
- 9. CONT Age ( > 60y for DLT, > 65y for SLT ) Previous thoracic surgery Peripheral vascular disease Corticosteroid dependence
- 10. INDICATION ENTITIES ISSUES
- 11. OBSTRUCTIVE LUNG DISEASE COPD α 1 anti-trypsin deficiency Bronchiolitis obliterans syndrome
- 12. ISSUES Cor pulmonale, RHF CAD Pneumothorax during intubation, CVC insertion Ventilatory strategies?
- 13. RESTRICTIVE LUNG DISEASE: Idiopathic pulmonary fibrosis Connective tissue disorders Drug or radiation induced disease
- 14. ISSUES Difficult ventilation Needs high inflating pressures ( 40 cm H2O ) Pressure controlled ventilation with PEEP ICU ventilator
- 15. SUPPURATIVE LUNG DISEASE Cystic fibrosis Non CF bronchiectasis Single lung transplant: contraindicated
- 16. ISSUES OLV mandatory Needs frequent intra operative toileting High inflation pressure Difficult ventilation High end antibiotics Povidone iodine irrigation after pneumonectomy Burkholderia cepacia on BAL: CONTRAINDICATION
- 17. PULMONARY VASCULAR DISEASES Idiopathic Secondary to COPD, pulmonary fibrosis Connective tissue disorders Intracardiac shunting due to Eisenmenger’s syndrome
- 18. ISSUES Can crash on induction Lines under local, including femoral arterial line Surgeon and CPB machine ready prior to induction
- 19. RELEVANT INVESTIGATIONS Blood picture PFT DLCO Lung perfusion scan 2D ECHO, DSE, Perfusion scan Cardiac catheterization HLA typing
- 20. THORACIC EPIDURAL ANALGESIA Excellent analgesia Use of CPB : a hurdle Can be placed previous night Useful in bilateral lung transplants Paravertebral catheters for unilateral surgeries
- 21. MONITORING Standard including ETCO2 Temperature RGM Spirometry
- 22. CONT TOF ABP, CVP PCWP Cardiac output
- 23. VASCULAR ACCESS Large bore peripheral lines Arterial line Central venous line/ AVA PAC STRICT ASEPSIS
- 24. TEE Improves standard of care Lot of information ACC/AHA/ASE: Class 2 b indication
- 25. INDICATIONS OF TEE Pulmonary hypertension Right ventricular dysfunction Suspicion of a patent foramen ovale
- 26. INFORMATION PROVIDED BY TEE Left and right sided preload Left and right ventricular function Regional wall motion abnormalities Intracardiac air Detects intra cardiac thrombus Detects shunting: unexplained hypoxemia
- 27. INDUCTION Avoid myocardial depression Avoid hyperinflation of lung Avoid increase in RV afterload
- 28. CHOICE OF ETT Left DLT ideal Lot of advantages of DLT over regular ETT DLT to ETT at the end with tube exchanger Bronchial blocker can be used for single lung transplants
- 29. CPB IN LUNG TRANSPLANT Pulmonary hypertension Simultaneous cardiac surgery Patients requiring plasma pheresis for HLA mismatch HLA antibodies against donors
- 30. CONT Not tolerating OLV Not tolerating PA clamping ( RVF ) Hemodynamic instability If PA pressure don’t reduce after perfusing first lung ECMO dependent patient
- 31. CPB? Beating heart CPB Cardioplegia used in simultaneous cardiac surgeries
- 32. ADVANTAGES OF CPB Hemodynamic stability Controlled reperfusion of grafts
- 33. DISADVANTAGES OF CPB Hemolysis AKI ALI TRALI Mechanical ventilation Pulmonary edema
- 34. RV FAILURE At induction OLV Hilum manipulation PA clamp After reperfusion Severe early graft dysfunction
- 35. RV AFTERLOAD REDUCTION Correct parameters Milrinone, Noradrenaline, adrenaline Pulmonary vasodilatation: 100% O2, NO PGI2 Inhaled milrinone ??
- 36. POST OPERATIVE MANAGEMENT Extubation after SLT Pain management Bronchodilators NIV Chest PT DVT prophylaxis
- 37. VENTILATION Use of CPB Core hypothermia Unstable patient Bilateral lung transplant
- 38. IMMEDIATE POST OP ISSUES Luxury perfusion Anastomotic dehiscence Stenosis Hyperinflation of native lung Infectious complications PRIMARY GRAFT DYSFUNCTION
- 39. SUMMARY Application of cardiac & thoracic anesthesia Multidisciplinary approach Rigorous evaluation Hemodynamic management Evidence based practice