[Anesthesiological management of heart transplantation: some historical aspects and the modern state of the problem].
The author discusses some historical aspects of anesthesia for heart transplantation in Russia and other countries. The original study included 31 heart recipients aged 16 to 54. The duration of heart conservation was 2 to 6.6 hours. The optimal anesthesia consisted in a combination of fentanyl in low doses with midazolam and isoflurane. All the recipients needed intensive inotropic support with different sympathomimetic drug combinations following the reestablishment of transplanted heart functioning. There was a significant correlation between the duration of heart conservation and the doses of epinephrine (r = 0.51; p = 0.017). In most recipients with a duration of heart anoxic period of less than 2.5 hours, heart functioning proved to be possible to normalize with a dopamine-dobutamine combination. Epinephrine was the main agent in recipients with a longer period of heart anoxia. There was a significant correlation between the duration of heart conservation and systemic vascular resistance following cardio-pulmonary bypass. Epinephrine and norepinephrine were applied in combination with nitric oxide inhalation to prevent negative pulmonary vasoconstrictor effect of epinephrine and norepinephrine.
Kozlov
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D000758:Anesthesia / Q000379:methods / Q000592:standards / Q000639:trends; D002315:Cardiopulmonary Bypass / Q000379:methods / Q000592:standards; D006331:Heart Diseases / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods* / Q000639:trends; D006801:Humans; D016896:Treatment Outcome