title: Anesthesia for bilateral sequential lung transplantation: experience of 64 cases.
abstract: OBJECTIVE
  To review the experience of anesthesia for bilateral sequential lung transplantation (BSLTx) and describe factors associated with outcome.
  
  
  METHODS
  Case series.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Sixty-four adult patients undergoing BSLTx.
  
  
  METHODS
  Descriptive and inferential statistical analysis.
  
  
  RESULTS
  Details of anesthetic technique, patient, and perioperative characteristics are presented. Mean (SD) lung allograft ischemic times were 320 (81) minutes for the first lung and 446 (93) minutes for the second lung. Mean (SD) duration of surgery was 8.5(2) hours, and median time to extubation was 28 hours. There was a reduction in the use of cardiopulmonary bypass, from 10 of 19 (53%) in 1992 to 1993 to 10 of 45 (22%) in 1994 to 1996, p = 0.016. There was an association between time to extubation and duration of surgery (Spearman rank correlation, p = 0.33, p = 0.008), but no association with intraoperative fluid administration (p = 0.18, p = 0.16), or inotrope requirements (p = 0.06, p = 0.65). Predictors of in-hospital mortality were preoperative renal impairment (p = 0.034), early reoperation (p = 0.005), and delay in extubation (p = 0.013); and for 12-month mortality was patient age (p = 0.01). The actuarial survival rates were 90%, 73%, and 58% at 30 days, 1 year, and 2 years, respectively.
  
  
  CONCLUSIONS
  Anesthesia for BSLTx is a most challenging procedure, for which maintenance of tissue oxygenation and right ventricular perfusion are essential. Recent advances include use of inhaled nitric oxide, ventilator management that reduces dynamic hyperinflation, and permissive hypercapnia. Analysis of outcome from a large case series such as this enables the anesthesiologist to be more aware of the important features of anesthesia for BSLTx, as well as identify potential areas of improvement.
authors.affiliation: Department of Anaesthesia and Pain Management, Alfred Hospital, Victoria, Australia.
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
authors.forename: A M
authors.initials: AM
authors.lastname: Weeks
authors.forename: M R
authors.initials: MR
authors.lastname: Buckland
authors.forename: A
authors.initials: A
authors.lastname: Silvers
authors.forename: M
authors.initials: M
authors.lastname: Bujor
authors.forename: M
authors.initials: M
authors.lastname: Langley
mesh_terms: D000328:Adult; D000758:Anesthesia / Q000379:methods*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged