Abstract:

Objective To summary the application value of pulmonary sequestration，anesthesia management and extracorporeal membrane oxygenation（ECMO）during lung transplantation anesthesia. Methods Clinical data of 330 cases of lung transplant recipients were collected，age 51.4±9.6 yearsold，ASA grade Ⅲ or Ⅳ . All patients were treated with preoperative oxygen clinotherapy，including 6 cases with tracheotomy and 12 cases with tracheal intubation and respiratory support. During the surgery, all patients were treated by intravenous injection of midazolam 0.05-0.1 mg/kg，fentanyl 4 μg/kg，etomidate 0.2-0.4 mg/kg and vecuronium 0.1 mg/kg. A double lumen bronchial tube，a single chamber double balloon catheter（Univent tube） or a bronchial obstruction wasselected according to the need of operation. Ventilation mode was used in pressure control，and the parameters were adjusted according to the blood gas index and vital signs，manual ventilation if necessary. ECMO was used in patients who could not tolerate single lung ventilation and cardiac dysfunction during surgery. Results 132 patients underwent single lung transplantation patients，121 of them were treated with non operative side double lumenbronchial tube ；3 patients were treated with tracheotomy before operation and 6 cases were treated with bronchial obstruction. 2 of them were treated with short stature and Univent tube. There were 198 patients underwent bilateral lung transplantation，187 cases of them applied the left double lumen endobronchial tube，among which 5 cases replaced the tube due to surgical operation punctured the cuff，7 cases applied the left bronchial anastomosis return tube ；6 patients underwent Univent tube ；5 cases used endobronchial blocker. 5 cases of bronchiectasis patients and 3 idiopathic pulmonary fibrosis（IPF）patients had sputum obstruction after induction of anesthesia，4 cases turnedbetter after treatment，1 case died due to continuous hypoxemia. ECMO was used in 148 cases，including 69 cases of pulmonary hypertension，17 cases of cardiac insufficiency，57 cases of hypoxia and 5 cases of hypercapnia. 133 cases immediately removed ECMO after surgery，15 patients continued to use ECMO due to the hemodynamic instability and poor postoperative oxygenation. Conclusion Rational application of pulmonary sequestration technology is the premise of the completion of lung transplantation anesthesia ；The effective management of respiratory and circulation in the patients during the perioperative period is the basis of ensuring the success of operation ；ECMO is an effective method for lung transplantation，which can improve the success rate of anesthesia in lung transplantation.