Kinh nghiệm bước đầu gây mê hồi sức cho ghép phổi từ người cho chết não tại Bệnh viện Trung ương Quân đội 108: Báo cáo ca lâm sàng

Abstract

Report experience a successful case anesthesia and resuscitation of lung transplantation from brain-dead donor at the 108 Military Central Hospital. A 54-year-old man with ASA III, was diagnosed with end-stage COPD has indicated bilateral lung transplantation. Recipient was induced and maintained by propofol and remifentanil by Close-loop system under BIS guideline control, atracurium muscle relaxant. Control ventilation by double lumen tube Carlen 39Fr. Swan-Ganz catheter was introduced through a right internal jugular after induction aim to hemodynamic and pulmonary arterial pressure control, transesophageal echocardiography monitor cardiac status and the filling pressure, analgesia for post-operative by chirocain 0.125% and sufentanil 0.25µg/ml through the catheter epidural at T₅ - T₆. Avoid excessive fluid therapy intraoperative, blood pressure was supported with noradrenaline, pulmonary artery pressure control with NO, new lung ventilation side by side with 60 - 100% concentration oxygen during surgery. Anesthesia maintained the BIS value between 40 - 60, hemodynamic stability was maintained throughout the surgical procedure, pulmonary arterial pressure (PAP) maintained 25 - 30mmHg, pulmonary artery wedge pressure (PAWP) 10 - 15mmHg, SpO₂ stable at 95-100% with P/F between 250 - 400. After surgery the patient had no pain at all, wake up after 50 minutes, hemodynamically stable, patient was ventilated A/C support and extubation after 12 hours. Conclusion: Bilateral lung transplants can also be well controlled by double lumen tube endotracheal intubation. Avoid "wet" lungs with fluid restriction, hemodynamic control, and adequate pulmonary artery pressure. Choice short-acting anesthetics such as propofol, remifentanil, and postoperative analgesia are important factors. It helps the early weaning of mechanical ventilation and early extubation, successfully involved in lung transplantation.