title: The clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation.
abstract: OBJECTIVE
  We examined the clinical course of anesthetic induction in lung transplant recipients with pulmonary complications after hematopoietic stem cell transplantation (post-HSCT), focusing on ventilatory management. We aimed to determine the incidence of oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction in post-HSCT lung transplant recipients, and to explore factors associated with their development.
  
  
  METHODS
  Nineteen consecutive patients who underwent lung transplantation post-HSCT at Kyoto University Hospital (Japan) were retrospectively studied. Data regarding patient characteristics, preoperative examination, and clinical course during anesthetic induction were analyzed.
  
  
  RESULTS
  The incidence of oxygen desaturation (SpO2 < 90 %) during anesthetic induction and severe respiratory acidosis (pH < 7.2) after anesthetic induction were 21.1 and 26.3 %, respectively. Reduced dynamic compliance (Cdyn) during mechanical ventilation was significantly associated with oxygen desaturation during anesthetic induction (p = 0.01), as well as severe respiratory acidosis after anesthetic induction (p = 0.01). The preoperative partial pressure of carbon dioxide in arterial blood (PaCO2; r = -0.743, p = 0.002) and body mass index (BMI; r = 0.61, p = 0.021) significantly correlated with Cdyn, and multivariate analysis revealed that both PaCO2 and BMI were independently associated with Cdyn.
  
  
  CONCLUSIONS
  Oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction frequently occur in post-HSCT lung transplant recipients. Low Cdyn may, at least partially, explain oxygen desaturation during anesthetic induction and severe respiratory acidosis after anesthetic induction. Moreover, preoperative hypercapnia and low BMI were predictive of low Cdyn.
authors.affiliation: Department Anesthesia, Kyoto University Hospital, 54 Shogoin-Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan, mizota@kuhp.kyoto-u.ac.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mizota
authors.forename: Shino
authors.initials: S
authors.lastname: Matsukawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukagawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Daijo
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Fengshi
authors.initials: F
authors.lastname: Chen
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000293:Adolescent; D000328:Adult; D000777:Anesthetics / Q000008:administration & dosage*; D015992:Body Mass Index; D002245:Carbon Dioxide / Q000097:blood; D002648:Child; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D006935:Hypercapnia / Q000453:epidemiology; D015994:Incidence; D007564:Japan; D016040:Lung Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010313:Partial Pressure; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D000777:Anesthetics; D002245:Carbon Dioxide; D010100:Oxygen