title: Management of Anesthesia during Lung Transplantations in a Single Turkish Center.
abstract: OBJECTIVE
  The aim of this study is to present our institutional experience during the management of anesthesia in lung transplantation (LT) surgeries as a definitive surgical treatment option in end-stage lung diseases.
  
  
  METHODS
  From a total of 15 patients, lung transplantation was performed as single LT (SLT) in 4 patients (n = 4) and as sequential bilateral LT (BLT) in 11 patients (n = 11). The anesthetic management included; for induction; intravenous ketamine, midazolam at doses of 2 mg/kg, 0.05 mg/kg, respectively or propofol, fentanyl at doses of 1 mg/kg, 3 mcg/kg, respectively. For maintenance, all patients received; 100% O2 and total intravenous infusion of propofol and remifentanil at doses of 0.02 mcg/kg/min and 0.1-0.25 µg/kg/min, respectively. All patients received intravenous rocuronium bromide for induction and maintenance. Hemodynamic stability was maintained with appropriate and adequate administration of vasodilators (intravenous Prostaglandin (PGI2) (0.5-1 ng/kg/min), inhaled   nitric oxide  (10-40 ppm),  dopamine (2 mcg/kg/min) and vasopressors (intravenous dobutamine (5-15 mcg/kg/min), norepinephrine (0.05-1 mcg/kg/min),ephedrine (5 to 10 mg bolus doses ) to keep mean arterial blood pressure above 50 mmHg.
  
  
  RESULTS
  Cardiopulmonary bypass (CPB) was performed in five patients who underwent sequential BLT and one SLT case. Venoarterial (VA) extracorporeal membrane oxygenation (ECMO) was used in four cases of sequential BLT and in two cases of SLT. Neither ECMO nor CPB was performed in two BLT and in one SLT patient. One SLT patient who underwent CPB was admitted to the intensive care unit with support of intra-aortic balloon pump (IABP) and ECMO. Intraoperative death did not occur.
  
  
  CONCLUSIONS
  During SLT or BLT, management of anesthesia with propofol and remifentanil provides a stable hemodynamic and medical support. Although our experience with VA ECMO was limited, our experience shows that this support system is a valuable tool to provide hemodynamic stability for patients undergoing LT.
authors.affiliation: Assoc. Prof. Dr. Medeniyet University, Göztepe Training and Education Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
authors.forename: Tülin
authors.initials: T
authors.lastname: Akarsu Ayazoğlu
authors.affiliation: Specialist Dr. Kartal Koşuyolu Training and Education Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
authors.forename: Aynur
authors.initials: A
authors.lastname: Ozensoy
authors.affiliation: Specialist Dr. Kartal Koşuyolu Training and Education Hospital, Department of Cardiac Thoracic Surgery, Istanbul/ Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Dedemoğlu
authors.affiliation: Specialist Dr. Kartal Koşuyolu Training and Education Hospital, Department of Anesthesiology and Reanimation, Istanbul, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Baysal
authors.affiliation: Specialist Dr. Istanbul Bilgi University, health Sciences School, Department of Persusion, Istanbul, Turkey.
authors.forename: Yasar G
authors.initials: YG
authors.lastname: Gul
authors.affiliation: Assist Prof. Dr. Erzincan University, Department of Anesthesiology and Reanimation, Erzincan/ Turkey.
authors.forename: Didem
authors.initials: D
authors.lastname: Onk
authors.affiliation: Assist Prof. Dr. Erzincan University, Department of Cardiac Thoracic Surgery, Erzincan, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Onk
mesh_terms: D000293:Adolescent; D000328:Adult; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D010880:Piperidines / Q000008:administration & dosage*; D015742:Propofol / Q000008:administration & dosage*; D000077208:Remifentanil; D014421:Turkey
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol