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KMID : 0367219960130010045
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Sejong Medical Journal
1996 Volume.13 No. 1 p.45 ~ p.54
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Analysis of Anesthetic Management of 16 Cases of Heart Transplantation at Sejong General Hospital
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Abstract
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First heart transplantation was performed in Sejong General Hospital on April, 1994. After first successful transplantation, cases tended to increase year by year. From April, 1994 to February, 1996, total 16 cases of heart transplantation were
performed with increasing successful results. We analyzed anesthetic management of our cases of heart transplantion in terms of demographic data of donors and recipients, anesthetic agents and methods, postoperative care including postoperative
complications etc.
The results were as follows:
1) Age of recipient was between 11 and 58. And age of donor was between 16 and 49.
2) Eleven cases of male donor to male recipient were the most common type of transplantation, the least was one case of female to female.
3) Diseases of recipient were 13 cases of dilated cardiomyopathy, one case of valvular, one case of ischemic and one case of congenital heart disease. Causes of brain death were 9 cases of trauma, 6 cases of intracranial hemorrhage and one case
of
brain tumor.
4) Mean ejection fraction of recipients was 25±12%, and mean pulmonary capillary wedge pressure was 22±9mmHg.
5) Balanced anesthesias by high dose of fentanly concomittant use of sedatives with low concentration of isoflurane were main methods for transplantation. 5~10ug/㎏min dobutamine and 0.5~2ug/㎏/min nitroglycerin were main inotropic and
vasodilator
respectively after transplantion.
6) Mean graft ischemia time, cardiopulmonary bypass time, and total anesthesia time was 122±74.9 min, 163±84.9 min, and 375±118.2 min respectively.
7) Endotracheal tubes of most cases were extubated mainly within postoperative 48 hours.
8) Major complications of heart transplantation were low cardiac output syndrome, bleeding, wound infection, renal failure, and peritonities etc. in descending order.
9) There were two cases of one month mortality. Sepsis and pulmonary edema were main causes of death respectively.
Conclusively, we expect increasing cases of transplantation under general concensus of usefulness of organ donation. So, we need more experiences and knowledge of anesthetic management of heart transplantation and postoperative care for more
successful
heart transplantation.
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