Lung transplants: An anesthesiologist’s vigilance

It’s 3 a.m., and an experienced hand gently squeezes the first breath into a patient’s newly perfused lung.physician examines monitors

On lung transplant time, vigilance is the defining word for anesthesiologists. While cases can start at any time of day, preparations often begin 8 to 12 hours in advance. Myriad uncertainties from a variety of factors define these high-pressure procedures. But once it’s go time, it’s the anesthesiology team that stands vigil, sometimes for 8, 10, or 14 hours at a stretch late into the night or early into the morning, dosing and redosing, monitoring and testing, ensuring the patient’s safe passage.

This year, UF Health Shands Hospital is on target to perform over 100 lung transplants. As of January, the program’s one-year postoperative survival rate was ranked the best in the country at 98%, almost 10% higher than the national average, according to the Scientific Registry of Transplant Recipients. Similarly, the waitlist mortality rate is extremely low at 4%, versus the national average of 18%, which is one of the lowest in the country. The waiting time to transplant was an impressive average of only 1.2 months

As of March, UF Health had already performed 15 double-lung transplants in patients whose lungs were irreversibly damaged from COVID-19 infection. UF Health is one of only a few elite institutions in the country to have performed COVID-related lung transplants.

So many healthcare providers and services are essential to the success of lung transplants, including teams of subspecialty-trained physicians, highly skilled nurses, perfusionists, ECMO specialists, surgical technicians, respiratory and physical therapists, and transplant coordinators. For anesthesiologists, these procedures are among the most challenging and demanding of all anesthesia cases. To better understand the role of anesthesiologists, we shadowed an attending for a recent double-lung transplant.

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