title: [Anesthetic complications in sequential bipulmonary transplantation in patients with cystic fibrosis. Apropos of 6 cases].
abstract: Cystic fibrosis (CF) is a disease characterized mainly by altered exocrine gland function that eventually produces irreversible dysfunction of the pancreas and lungs. The respiratory insufficiency that develops in CF patients in the advanced stages of disease can only be corrected at this time by lung or heart-lung transplantation. We describe our experience with 6 terminal phase CF patients who underwent sequential double lung transplantation (SDLT). Anesthesia was intravenous, with exhaustive hemodynamic and respiratory monitoring. During surgery the most frequently encountered hemodynamic complications were low minute volume, arterial hypotension and irregular heart rate. The main respiratory complications were hypoxemia, hypercapnia and pulmonary edema of the implanted lung, which developed in all cases to varying degrees related to the organ's state of preservation and duration of ischemia. Other complications were the need for extracorporeal circulation in 1 case, oliguria and blood loss requiring multiple transfusions. The most critical moments were at the time of clamping the pulmonary artery, the period after revascularization of the donated lung, and at the start of patient ventilation through the first implanted lung so that the second could be implanted. Although our series is small, it is of interest given the limited Spanish experience with lung transplantation in CF patients, and the good early results obtained, which are similar to those reported for other diseases.
authors.affiliation: Servicio de Anestesiología-Reanimación, Neumología y Cirugía Torácica, Hospital Universitario La Fe, Valencia.
authors.forename: L M
authors.initials: LM
authors.lastname: López
authors.forename: R
authors.initials: R
authors.lastname: Vicente
authors.forename: F
authors.initials: F
authors.lastname: Ramos
authors.forename: L
authors.initials: L
authors.lastname: Palacios
authors.forename: A
authors.initials: A
authors.lastname: Calvo
authors.forename: S
authors.initials: S
authors.lastname: Hernández
authors.forename: J M
authors.initials: JM
authors.lastname: Borro
authors.forename: P
authors.initials: P
authors.lastname: Morales
authors.forename: R
authors.initials: R
authors.lastname: Montero
mesh_terms: D000293:Adolescent; D000328:Adult; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000009:adverse effects* / Q000494:pharmacology; D003550:Cystic Fibrosis / Q000601:surgery*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D011229:Preanesthetic Medication; D012120:Respiration Disorders / Q000139:chemically induced*
chemical_list: D018686:Anesthetics, Intravenous