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Canadian Journal of Anaesthesia

, Volume 40, Issue 10, pp 981–986 | Cite as

Anaesthesia for non-cardiac surgery in heart-transplanted patients

  • D. C. H. Cheng
  • D. D. Ong
Brief Review

Abstract

This review documents the anaesthetic management, haemodynamic function and outcome in 18 of 86 heart-transplanted recipients, who returned for 32 non-cardiac surgical procedures at the Toronto Hospital from 1985 to 1990. General anaesthesia was administered in eight of the 27 elective operations and four of the five emergency operations. Induction medications included thiopentone (2–4 mg· kg−1), fentanyl (1–7 μg· kg−1) and succinylcholine (1–1.5 mg· kg−1). Anaesthesia was maintained with a combination of oxygen /nitrous oxide and isoflurane or enflurane. Muscle relaxation was maintained with vecuronium or pancuronium. No delayed awakening or unplanned postoperative ventilation was observed. Neuroleptanaesthesia was administered to 63.0% and 20.0% of the elective and emergency operations, respectively. The anaesthetics included fentanyl (25–100 ng) and midazolam (0.5–1.5 mg) or diazemuls (2.5–5.0 mg). Spinal anaesthesia (75 mg lidocaine) was administered to only two of the 27 elective operations. No important haemodynamic changes were observed in any anaesthetic group, but lower systolic BP was found after induction and during maintenance periods in the patients who received general anaesthesia than in those who received neurolept-anaesthesia. However, no anaesthesia-related morbidity or mortality was noted. This suggests that general, neurolept- and spinal anaesthesia do not affect haemodynamic function or postoperative outcome in heart-transplanted recipients undergoing subsequent non-cardiac surgery.

Key word

anaesthesia: outcome surgery: transplantation, heart 

Résumé

Cet article documente la conduite anesthésique, la fonction hémodynamique et l’évolution de 18 des 86 transplantés cardiaques qui sont revenus pour 32 interventions chirurgicales non cardiaques à l’Hôpital de Toronto de 1985 à 1990. Une anesthésie générale a été administrée pour huit des 27 interventions programmées et pour quatre des cinq interventions d’urgence. Les agents d’induction comprenaient du thiopental (2.0–4.0 mg · kg−1), du fentanyl (1,0-7.0 μg · kg−1) et de la succinylcholine (1,0-1,5 mg· kg−1). L’anesthésie a été entretenue avec une combinaison d’oxygène/protoxyde d’azote et isoflurane ou enflurane. La relaxation musculaire a été maintenue avec du vécuronium ou du pancuronium. On n’a pas observé de réveil retardé ni de ventilation post-opératoire imprévue. Une neuroleptanesthésie a été administrée à 63,0% des interventions programmées et à 20% des interventions urgentes. Les agents étaient du fentanyl (25–100 μg) et du midazolam (0,5–1,5 mg) ou du diazemul (2,5–5 mg). L’anesthésie rachidienne (75 mg de lidocaïne) n’a été administrée qu’à seulement deux des 27 opérations programmées. Dans aucun groupe, on n’a observé de variations hémodynamiques importantes, mais une pression artérielle systolique plus basse a été notée après l’induction et pendant les périodes d’entretien chez les patients qui ont reçu une anesthésie générale par rapport à ceux qui ont reçu une neuroleptanesthésie. On n’a cependant pas enregistré de morbidité ni de mortalité en rapport avec l’anesthésie. Ceci suggère que l’anesthésie générale, la neuroleptanesthésie, ou l’anesthésie rachidienne n’affecte pas la fonction hémodynamique ou l’évolution post-opératoire chez les patients transplantés qui ultérieurement subissent une chirurgie non cardiaque.

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Copyright information

© Canadian Anesthesiologists 1993

Authors and Affiliations

  • D. C. H. Cheng
    • 1
  • D. D. Ong
    • 1
  1. 1.Department of AnaesthesiaUniversity of Toronto, The Toronto Hospital, Toronto General DivisionToronto

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