Atakan ERKILINÇ, Mustafa Emre GÜRCÜ, Pınar KARACA BAYSAL

Akciğer naklinde anestezi yönetimi: Tek merkez deneyimimiz

yönetim stratejilerimiz, deneyimlerimiz ve sonuçlarımız tartışıldı. Çalışma planı: Aralık 2016 - Aralık 2018 tarihleri arasında, merkezimizde akciğer nakli yapılan toplam 53 hasta (43 erkek, 10 kadın; ort. yaş: 46.1±13 yıl; dağılım, 14-64 yıl) çalışmaya alındı. Kullanılan anestezi tekniği, hastaların özellikleri ve perioperatif klinik ve takip verileri kaydedildi. Akciğer hastalığının evresi, New York Kalp Derneği fonksiyonel sınıflamasına göre değerlendirildi. Bulgular: İki hastaya tek taraflı akciğer nakli ve 51 hastaya çift taraflı akciğer nakli yapıldı. İdiyopatik pulmoner fibroz, hastaların %41.5’inde en sık endikasyon idi. Hastaların tümünde son dönem akciğer hastalığı (Sınıf IV) mevcut idi ve %79’u oksijene bağımlı idi. Otuz iki hastaya ekstrakorporeal membran oksijenasyon desteği verildi. Sonuç: Akciğer naklinde anestezi yöntemi, gerek alıcının fiziksel performansının kötüleşmesi, gerekse kullanılan cerrahi tekniklerin karmaşık yapısı nedeniyle zordur. Genel olarak, bir çeşit mekanik destek gerekebilir ve hastaların birçoğunda ekstrakorporeal membran oksijenasyonu ilk tercihtir. İdeal bir multidisipliner yaklaşım sağlamak ve başarılı sonuçlar elde etmek için cerrahlar, perfüzyonistler ve anesteziyolojistlerin arasında iyi bir iletişim kurulmalıdır.

Anesthetic management in lung transplantation: Our single-center experience

Background: In this study, we aimed to discuss our anesthesia management strategies, experiences, and outcomes in patients undergoing lung transplantation. Methods: Between December 2016 and December 2018, a total of 53 patients (43 males, 10 females; mean age: 46.1±13 years; range, 14 to 64 years) undergoing lung transplantation in our center were included. The anesthesia technique, patients’ characteristics, and perioperative clinical and follow-up data were recorded. The stage of lung disease was assessed using the New York Heart Association functional classification. Results: Two patients underwent single lung transplantation, while 51 patients underwent double lung transplantation. Idiopathic pulmonary fibrosis was the most common indication in 41.5% of the patients. All patients had end-stage lung disease (Class IV) and 79% were oxygen-dependent. The extracorporeal membrane oxygenation support was given to 32 patients. Conclusion: The anesthetic management of lung transplantation is challenging, either due to the deterioration of the recipient’s physical performance and the complexity of the surgical techniques used. In general, a kind of mechanical support may be needed and extracorporeal membrane oxygenation is the first choice in the majority of patients. A close communication should be maintained between the surgeons, perfusion technicians, and anesthesiologists to ensure an optimal multidisciplinary approach and to achieve successful outcomes.

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