Anesthetic considerations for lung transplantation

Lung transplantation is the definitive treatment for end-stage lung disease. The number of lung transplantations performed is limited by the number of donors available and is far outnumbered by the potential recipients on the waiting list. Advances in surgical methods, organ preservation, and immunosuppression have decreased the morbidity and mortality associated with this procedure during the last few decades. Specific anesthetic concerns are associated with lung transplantation, including careful preoperative assessment of pulmonary and cardiac function, adequate venous access and monitors, and ventilation techniques, such as 1-lung ventilation and lung-protective strategies to decrease the risks of reperfusion injury, barotrauma, and re-expansion pulmonary edema. Intraoperative transesophageal echocardiography, cardiopulmonary bypass, and inhaled nitric oxide can also be important tools for the anesthesiologist to optimize patient care during this challenging procedure.