Anaesthetic management for lung transplantation

Lung transplantation due to suppurative, obstructive, restrictive and/or vascular lung diseases presents anesthesia teams with a challenge: This type of intervention involves a range of potential complications during administration of anesthesia and thus requires different management strategies. The present contribution describes lung transplantation specific requirements as to patient assessment, premedication, thoracic epidural analgesia, monitoring and vascular access techniques, induction and maintenance of anesthesia, etc. Special focus lies on the patient’s pulmonary pathology with its ensuing specific risks as well as on the anesthesia-related particularities during the different stages of surgery. To consider anesthetic management for lung transplantation as a cardiac anesthesia with a doublelumen tube and a noradrenaline infusion is an over-simplification of this special type of intervention. Potential intra-operative complications which have to be dealt with vary tremendously depending on the lung transplant recipient’s underlying pathology.