Anaesthesia For Patients Undergoing Lung Transplantation

Lung transplantation comprises a family of operationsincluding single lung transplant, bilateral single lung transplant,lobar transplant and block heart-lung transplant.Improved donor lung preservation techniques have increasedthe duration of cold ischaemia time. The advent of bilateral singlelung transplant has decreased the requirement for cardiopulmonarybypass, and airway complications have been reduced by adoptionof the telescoping bronchial anastomosis .Advances in perioperative monitoring (includingtransoesophgeal echocardiography), pulmonary vasodilators (nitricoxide and prostaglandin E1). cardiopulmonary bypass andventilatory management and a better understanding of thepathophvsiological process during the procedure have improvedperioperative anaesthesia management. Also advances in broadspectrum antibiotics and immunosuppressant agents have improvedthe outcome by better management of the complications ofinfection and rejection .The major limitation of the procedure related to the highercosts with marginal improvement in life expectancy compared withconservative treatement .As a result of increased number of the transplanted patients,more of these patients are presenting for surgery and anaesthesiaeither for emergency or elective surgery. To anaesthetists withlimited experience in this field, these patients have considerablemedical, physiological and pharmacological problems which needto be understood.Anaesthesia, local, regional. or general can be safelydelivered to these patients provided that the physiology andpathophsiology of the transplanted lung, the phannocology of theimmunosuppressive agents, and the underlying surgical condititionare understood.Conclusion ; Although the future of lung transplantationseems promising with potential for rapid growth, its economicimpact on the care system will continue to draw attention