Anesthesia management of a patient with heart transplant for non-cardiac surgery – case report and literature review

Od prve transplantacije srca 1967. u svijetu se na godinu izvede oko 3500 novih transplantacija srca, uz prosječno posttransplantacijsko preživljenje od 15 godina. Danas je sve češće da skupina pacijenata s transplantiranim srcem bude podvrgnuta nekardijalnim operacijama, što je novi izazov za anesteziološko zbrinjavanje zbog patofizioloških i farmakoloških interakcija s denerviranim presatkom srca, nuspojava imunosupresivne terapije, rizika od infekcije i odbacivanja transplantata. U ovom prikazu pacijentici s transplantiranim srcem potpuno je uklonjena štitnjača (tiroidektomija) zbog papilarnog karcinoma štitnjače. Pacijentica je bila I. kategorije prema klasifikaciji NYHA-e (New York Heart Association) i III. kategorije prema klasifikaciji ASA-e (American Society of Anesthesiologists), uz urednu funkciju alopresatka i stabilan sinusni ritam. Zahvat je izveden u općoj endotrahealnoj anesteziji. Neuromuskularni blok prekinut je sugamadeksom (Bridion®, Merck) i bolesnica je otpuštena kući nakon 3 dana.Since the first human cardiac transplantation in 1967, approximately 3,500 heart transplants are performed every year in the world and post-operation survival period average is 15 years. Due to these facts these patients are now presenting for various non-cardiac procedures. The information regarding the physiological and pharmacological interactions in a denervated allograft heart, the side-effects of immunosuppression, the risk of infection, and the potential for rejection is essential for anesthetic management. This case report reviews the anesthetic management of a heart transplant recipient undergoing a total thyroidectomy. She was NYHA I, ASA grade III with normal alograft function and sinus rhythm. Anesthesia was performed in general endotracheal anesthesia. Neuromuscular block was reversed with sugammadex and she was discharged after three days