RESUMEN
Respiratory failure requiring intubation has traditionally been a relative contraindication to lung transplantation due to increased morbidity and mortality. Advances in extracorporeal membranous oxygenation (ECMO) have made it possible to extubate patients and provide physical therapy with minimal native lung function. By "bridging" patients to lung transplant using ECMO, they are able to undergo rehabilitation and withstand the demands of surgery. However, providing anesthesia for these cases requires an understanding of ECMO physiology and the pharmacology associated with ECMO. We describe the anesthetic for four patients who were bridged to lung transplant and the complexities of their perioperative management.
Asunto(s)
Oxigenación por Membrana Extracorpórea/métodos , Trasplante de Pulmón/métodos , Atención Perioperativa/métodos , Insuficiencia Respiratoria/terapia , Adulto , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/cirugía , Resultado del TratamientoRESUMEN
Buprenorphine is a partial agonist/antagonist used for the outpatient management of pain and addiction. It avidly binds to the opioid receptors and has a long and varied half-life. Its effects can impair the efficacy of opioids used for postoperative pain. The authors present a case of a patient managed with buprenorphine as an outpatient who presented for revision spine surgery and had significant postoperative pain that was successfully treated with hydromorphone and dexmedetomidine. This is the first reported use of dexmedetomidine for postoperative pain in a patient treated with buprenorphine.