Chapter 17 - Management during surgery

Summary

Thoracic epidural analgesia should be considered in all cases, but may be most safely sited postoperatively. In addition to the usual anesthetic issues of aspiration risk, airway assessment, comorbidities, medications, and adverse reactions, assessment on the day of surgery focuses on the current illness state and amount of deterioration since investigations were performed, as the patient's physical state may be significantly worse than investigations may suggest. Mandatory monitoring includes five-lead electrocardiography, pulse goniometry, invasive measurement of arterial, central venous, and pulmonary artery (PA) pressures; urine output via an indwelling catheter, temperature, oceanography, pyrometer and anesthetic agent gas analysis. Maintenance of anesthesia by protocol infusion, inhalational anesthetic agent, or both has been described. Most patients with end-stage parenchyma lung disease can get symptomatic improvement with single lung transplantation (SLT). Primary graft dysfunction (PGD) is a devastating complication akin to acute lung injury due to the transplantation process.