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14 results

  • Chapter 7 - Uncommon Respiratory Disorders in Pregnancy

  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Grace Lim, University of Pittsburgh
  • Book:
    Obstetric Anesthesia and Uncommon Disorders
    Published online:
    26 January 2024
    Print publication:
    01 February 2024, pp 79-96

  • Summary

    The physiologic and hormonal stresses that occur during pregnancy and labor have the potential to worsen existing respiratory disease and can pose unique challenges in management for the obstetrician and obstetric anesthesiologist. Cases of respiratory disease in pregnancy require specific planning and management to optimize maternal and fetal outcome. This chapter discusses rare respiratory disorders that the obstetric anesthesiologist may encounter in practice: acute respiratory distress syndrome, cystic fibrosis, pneumothorax, status asthmaticus, thromboembolic disease, mediastinal mass, congenital central hypoventilation syndrome, pulmonary lymphangioleiomyomatosis, restrictive and interstitial lung disease, transfusion related acute lung injury, transfusion-associated circulatory overload and lung transplantation. The aim is to present relevant discussion in order provide the anesthesiologist with some background and evidence to support her/his decision-making when encountering these rare and challenging cases.

  • Chapter 28 - Sensitization of kidney transplant recipients

  • from Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 238-247

  • Summary

    This chapter focuses on postoperative fluid management and early complications of lung transplantation (LT). Patients with emphysema who undergo single LT (SLT) require special attention to airway pressures and the compliance difference between the allograft and the native lung. Postoperative antimicrobial coverage should be modified if pathogens are identified in the sputum of the donor that is not already covered by the recipient-specific regimen. Postoperative hemodynamic instability has been common in patients with underlying pulmonary hypertension. Maintaining optimal nutrition in the postoperative period is essential and may improve operative outcomes. Early complications of LT can be classified into four categories: complications of the surgery itself, re-implantation response and primary graft dysfunction (PGD), immunologic complications including rejection, and organ-specific complications of the immunosuppressive agents. Standard therapy is recommended in the early post-transplant setting, although a focal structural abnormality may require surgical removal if it becomes the source of recurrent infection.

  • Chapter 29 - Live donor kidney donation

  • from Section 5 - Kidney
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 248-252

  • Summary

    This chapter presents a commentary on the lung-specific complications following transplantation and this should be used to drive the investigation plan and management. Shared care protocols with effective communication should be organized in patients who live at a distance from the transplant center to ensure that local follow-up includes monitoring of the lung function and imaging. Acute rejection can be identified on lung biopsies obtained via transbronchial biopsy (TBBx) at fiberoptic bronchoscopy. Many transplant centers perform regular bronchoscopy and TBBx in addition to spirometry in the first year to enable early diagnosis and treatment of asymptomatic rejection, with the aim of preserving graft function and protecting against bronchiolitis obliterans syndrome (BOS). Recently the importance of detecting early, subclinical BOS before irreversible fibroproliferative disease has become established has been recognized, and a new stage of BOS 0-p has been added.

  • Chapter 6 - Recipient selection

  • from Section 2 - Heart
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 63-69

  • Summary

    Transplantation of organs represents the pinnacle of medical achievement in so many different ways. This chapter presents historical perspectives of organ transplantation such as abdominal organ transplantation, cardiothoracic transplantation, combined heart and lung transplantation and lung transplantation. The area of skin grafting became of greater importance for the treatment of war burns and other injuries, and the death from kidney disease also provided impetus to focus once more on kidney transplantation. The successful intrathoracic transplantation of the heart without interrupting the circulation led to the idea that a cardiac allograft might be able to assume some of the normal circulatory load. The indications for transplantation are widening, and although kidney, liver, heart, and even lung transplantation is now seen as routine, the necessary skills are being developed to transplant other organs, such as the small intestine, pancreas, face, hand, and uterus.

  • Chapter 23 - Surgical procedure

  • from Section 4 - Liver
  • Edited by Andrew A. Klein, Clive J. Lewis, Joren C. Madsen
  • Book:
    Organ Transplantation
    Published online:
    07 September 2011
    Print publication:
    11 August 2011, pp 190-198

  • Summary

    This chapter focuses on how to select patients who will gain maximum benefit from lung transplantation (LT). It outlines the general considerations and exclusions pertaining to all potential recipients and focuses on disease specific guidance for the major recipient groups: chronic obstructive pulmonary disease (COPD), cystic fibrosis (CF), idiopathic pulmonary fibrosis (IPF), and idiopathic pulmonary arterial hypertension (IPAH). Pulmonary infections with highly resistant bacteria have been shown to have poorer outcomes in comparison with non-infected patients. The presence of fungus in the native lungs can cause problems after LT and needs careful assessment in each individual. The presence of comorbidities outside of the failing respiratory system is important considerations that can impact patient outcomes. COPD accounts for approximately 40% of LTs performed, with CF and IPF accounting for 20% each. In the current era there remains a critical shortage of donor organs, and thus unfortunately, recipient selection remains extremely important.

  • Chapter 23 - Peri-operative intravenous fluid management

  • from Section 3 - Post-operative management
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 161-165

  • Summary

    The lung has historically been the most challenging of the human organs to be successfully transplanted in clinical practice. It is possible to transplant lungs singly (SLT) or sequentially as a bilateral lung transplant (BSLT) depending on patient characteristics and the nature of the pathological lung condition present. Lung transplant assessment tests typically include sputum tests for Aspergillus and Aspergillus precipitins. Right heart catheterization is undertaken in patients considered for lung transplantation for pulmonary hypertension. Smokers and patients with a history of mild asthma may still be considered as potential lung donors. At many centers, anesthesia for sequential bilateral lung transplantation is undertaken as sequential single lung transplants to avoid the perceived increase in acute lung injury post-operatively which is said to accompany extracorporeal perfusion. Immunosuppression commences pre-operatively with the administration of azathioprine and cyclosporin A. Quality of life is significantly improved by transplantation for pulmonary failure.

  • Chapter 22 - Management of thoracic surgical emergencies

  • from Section 2 - Anesthesia for operative procedures
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 151-158

  • Summary

    The primary cause of emphysema is cigarette smoking. Candidates for surgery for emphysema require a complete history and examination. Three surgical treatment strategies exist for selected subgroups of emphysema patients: bullectomy, lung volume reduction surgery (LVRS), and lung transplantation (LTx). Surgical stapling devices or lasers are used to resect and seal the least functional lung segments. Stapling methods and buttressing techniques have evolved to reduce the risk of air leaks. Formal LVRS comprises a range of pulmonary resection procedures designed to achieve improved gas exchange via volumetric reduction of emphysematous lung. Lung transplantation is now an established therapeutic option for end-stage emphysema. Patients are assessed according to consensus criteria provided by the International Society for Heart and Lung Transplantation (ISHLT). The primary limitation for LTx is the shortage of suitable allograft donors, and the mortality of advanced emphysema patients on the waiting list is high.

  • Chapter 25 - Management of post-operative respiratory problems

  • from Section 3 - Post-operative management
  • Edited by Cait P. Searl, Sameena T. Ahmed
  • Book:
    Core Topics in Thoracic Anesthesia
    Published online:
    10 December 2009
    Print publication:
    02 April 2009, pp 171-176

  • Summary

    Esophagectomy is commonly performed for cancer of the esophagus and gastric cardia. The surgical approach to esophagectomy depends on several factors: anatomic location of tumor; preferred method of reconstruction: transposed stomach, interposed colon, pedicled jejunum; and location of the esophageal-enteric anastomosis. Conventional esophagectomy requires either a laparotomy with a trans-hiatal dissection or laparotomy combined with thoracotomy. A trans-hiatal approach is the most commonly performed operation for esophageal cancer resection. Evidence of chronic pulmonary disease, the ability to stand one-lung anesthesia and the likelihood of post-operative pulmonary complications may be predicted with the aid of the lung function test and cardiopulmonary exercise testing. The spectrum of gastro-esophageal reflux disease (GERD) involves the gastrointestinal and pulmonary organ systems. There is an association between GERD and end-stage lung disease, especially idiopathic pulmonary fibrosis (IPF). The presence of GERD may predispose to the development of bronchiolitis obliterans following lung transplantation.

  • Complications related to the transplantation of thoracic organs: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

  • Part of
  • Howard Jeffries, Geoff Bird, Yuk Law, Gil Wernovsky, Paul Weinberg, Christian Pizarro, Giovanni Stellin
  • Journal:
    Cardiology in the Young / Volume 18 / Issue S2 / December 2008
    Published online by Cambridge University Press:
    01 December 2008, pp. 265-270

  • A complication is an event or occurrence associated with a disease or a healthcare intervention, which constitutes a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after an intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.

    The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to patients who have received transplantation of the heart, heart and lung(s) or lung(s). These specific definitions and terms will be used to track morbidity associated with transplantation in a common language across many separate databases.

    The complications of transplantation are known risks of congenital cardiac surgery. The purpose of this effort is to propose consensus definitions for post-transplant complications following cardiac surgery so that collection of such data can be standardized. Clinicians caring for patients who have had transplantation of thoracic organs will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing treatment strategies.

  • 12 - Ventilatory support: extreme solutions

  • Edited by Iain Mackenzie
  • Book:
    Core Topics in Mechanical Ventilation
    Published online:
    14 October 2009
    Print publication:
    30 October 2008, pp 222-229

  • Summary

    One of the extreme solutions for the management of ventilatory failure is to replace the lungs altogether, either by transplantation or by the use of machines. Once the transplant has been completed, the means used to support the new lungs are little different from those used for any other patient. In the context of severe respiratory failure, other solutions are therefore necessary to provide ventilatory support, either as a bridge to recovery or transplantation, or as long-term support in an increasingly elderly Western population. These solutions are based on various mechanical means that take over some of the lung functions. This chapter reviews some of the key clinical questions concerning the ventilation of the lung transplant recipient and mechanical support of the failing lung. Starting at the time of transplantation, pharmacological immunosuppression has to be continuously adjusted to balance the risks of infection or rejection.

  • 15 - Cardiorespiratory disorders

  • from Part III - Working with specific units
  • Edited by Geoffrey Lloyd, Priory Hospital, London, Elspeth Guthrie, University of Manchester
  • Book:
    Handbook of Liaison Psychiatry
    Published online:
    10 December 2009
    Print publication:
    24 May 2007, pp 365-389

  • Summary

    This chapter attempts to describe how psychosocial factors influence both cardiovascular and respiratory diseases. First, psychosocial factors may affect health-related behaviours such as smoking, diet, alcohol consumption, or physical activity, which in turn may influence the risk of coronary heart disease (CHD). Second, psychosocial factors may cause direct acute or chronic pathophysiological changes, possibly by their effect on neuroendocrine or immune systems. Third, access to and content of medical care may be influenced by social factors. The chapter explores psychological consequences of disorders such as CHD and chronic obstructive pulmonary disease (COPD). It discusses the psychological aspects of the transplantation of major organs such as heart and lung transplantations. In a study of 76 patients who were undergoing heart, heart and lung, or lung transplantation, 39% were suffering from psychiatric disorder and 58% reported sexual dysfunction.

  • Cost analysis of home monitoring in lung transplant recipients

  • Terrence J. Adam, Stanley M. Finkelstein, Stephen T. Parente, Marshall I. Hertz
  • Journal:
    International Journal of Technology Assessment in Health Care / Volume 23 / Issue 2 / April 2007
    Published online by Cambridge University Press:
    01 April 2007, pp. 216-222

  • Objectives: The University of Minnesota has maintained a home monitoring program for over 10 years for lung and heart–lung transplant patients. A cost analysis was completed to assess the impact of home monitoring on the cost of post-transplant medical care.

    Methods: Clinical information gathered with the monitoring system includes spirometry, vital signs, and symptom data. To estimate the impact of this system on medical costs, we completed a retrospective analysis of the effects of home monitoring on the cost of post-lung transplant medical care. The cost analysis used multivariate linear regression with inpatient, outpatient, and total medical care costs as the dependent variables. The independent variables for the regression include home monitoring adherence, underlying disease, ambulatory diagnostic group mapping variables, transplant type, and patient demographics.

    Results: The multivariate regression of the overall cost results predicts a 52.4 percent reduction in total costs with 100 percent patient adherence; this rate includes a 72.24 percent reduction in inpatient costs and a 46.6 percent increase in outpatient costs. The actual first year average patient adherence was 74 percent.

    Conclusions: Adherence to home monitoring increases outpatient costs and reduces inpatient costs and provides an overall cost savings. The break-even point for patient adherence was 25.28 percent, where the net savings covered the cost of home monitoring. This is well within the actual first year adherence rates (74 percent) for subjects in the lung transplant home monitoring program, providing a net savings with adherence to home monitoring.