Anesthetic management for orthotopic heart transplantation / 中华麻醉学杂志

ABSTRACT

From June 2004 to December 2005 anesthesia was done for 43 patients undergoing orthotopic heart transplantation (OHT) in Fuwai Hospital. Most patients were premedicated with oral diazepam 5-10 mg, and intramuscular morphine 0.2 mg?kg-1 and scopolamine 0.1-0.3 mg. Radial artery was cannulated and Swan-Ganz catheter was placed. ECG, direct BP, HR, CVP, PAP, CO, SpO2, SvO2, PETCO2 were monitored before and during operation. Anesthesia was induced with midazolam 1-3 mg, etomidate 0.2-0.3 mg?kg-1 , fentanyl 5-15?g?kg-1 or sufentanil 50-100?g, vecuronium 0.1 mg?kg-1 or rocuronium 0.6 mg?kg-1 , and maintained with isoflurane inhalation and propofol infusion and intermittent i. v. boluses of fentanyl or sufentanil and vecuronium. Hemodynamic suppression was mild during anesthesia. The average duration of aortic cross-clamping and CPB was 57-133 min and 123-230 min. The cardiovascular support used for weaning the patients from CPB included dopamine, ephedrine and isoproterenol. Nitroglycerin, NO and iloprost were administered for pulmonary artery vasodilation. Pacing was started at the termination of CPB because of bradycardia in 1 of 43 patients. Sinus rhythm appeared after the patients were weaned from CPB and the function of the transplanted heart was satisfactory. Basiliximab, cyclosporine A, cellcept and methyl prednisolone were administered for immunosuppression during perioperative period. Forty-two of the 43 patients were discharged from hospital without any rejection episodes or other complications. One patient died of multiple organ failure after heart-kidney transplantation.