Table 4 Intraoperative anesthetic management of lung transplantation in surveyed anesthesiologists’ hospitals.
From: A nationwide survey on current practices in anesthesia management for lung transplantation in China
All doctors (n = 70) | Intermediate (n = 28) | Senior (n = 42) | P value | |
|---|---|---|---|---|
Induction drug | ||||
Etomidate | 67 (95.7%) | 25 (89.3%) | 42 (100.0%) | 0.031 |
Propofol | 41 (58.6%) | 18 (64.3%) | 23 (54.8%) | 0.428 |
Ketamine | 7 (10.0%) | 2 (7.1%) | 5 (11.9%) | 0.694 |
Others | 18 (18.6%) | 7 (25.0%) | 6 (14.3%) | 0.259 |
Analgesia drug | ||||
Fentanyl | 5 (7.1%) | 1 (3.6%) | 4 (9.5%) | 0.641 |
Sufentanil | 70 (100.0%) | 28 (100.0%) | 42 (100.0%) | |
Remifentanil | 50 (71.4%) | 21 (75.0%) | 29 (69.0%) | 0.589 |
Ketamine | 2 (2.9%) | 1 (3.6%) | 1 (2.4%) | 1.000 |
Oxycodone | 17 (24.3%) | 7 (25.0%) | 10 (23.8%) | 0.909 |
Others | 3 (4.3%) | 0 (0.0%) | 3 (7.1%) | 0.270 |
Muscle relaxation drug | ||||
Rocuronium | 52 (74.3%) | 23 (82.1%) | 29 (69.0%) | 0.219 |
Vecuronium | 9 (12.9%) | 3 (10.7%) | 6 (14.3%) | 0.732 |
Cisatracurium | 58 (82.9%) | 25 (89.3%) | 33 (78.6%) | 0.338 |
Succinylcholine | 1 (1.4%) | 1 (3.6%) | 0 (0.0%) | 0.400 |
Others | 1 (1.4%) | 0 (0.0%) | 1 (2.4%) | 1.000 |
Maintenance of anesthesia | 0.466 | |||
Total intravenous anesthesia | 19 (27.1%) | 9 (32.1%) | 10 (23.8%) | |
Inhalation anesthesia | 1 (1.4%) | 0 (0.0%) | 1 (2.4%) | |
Inhalational-intravenous anesthesia | 50 (71.4%) | 19 (67.9%) | 31 (73.8%) | |
Inhalational anesthetic | ||||
None | 15 (21.4%) | 8 (28.6%) | 7 (16.7%) | 0.234 |
Sevoflurane | 56 (80.0%) | 21 (75.0%) | 35 (83.3%) | 0.393 |
Desflurane | 5 (7.1%) | 4 (14.3%) | 1 (2.4%) | 0.149 |
Isoflurane | 1 (1.4%) | 0 (0.0%) | 1 (2.4%) | 1.000 |
Lowest acceptable SPO2(%) | 0.617 | |||
< 85 | 8 (11.4%) | 2 (7.1%) | 6 (14.3%) | |
85–90 | 37 (52.9%) | 15 (53.6%) | 22 (52.4%) | |
90–95 | 25 (35.7%) | 11 (39.3%) | 14 (33.3%) | |
> 95 | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
Lowest acceptable Hb(g/L) | 0.981 | |||
< 80 | 9 (12.9%) | 4 (14.3%) | 5 (11.9%) | |
80–90 | 37 (52.9%) | 14 (50.0%) | 23 (54.8%) | |
90–100 | 19 (27.1%) | 8 (28.6%) | 11 (26.2%) | |
> 100 | 5 (7.1%) | 2 (7.1%) | 19 (27.1%) | |
Mechanical support | ||||
ECMO | 69 (98.6%) | 27 (96.4%) | 42 (100.0%) | 0.400 |
CPB | 8 (11.4%) | 4 (14.3%) | 4 (9.5%) | 0.705 |
Fluid therapy | ||||
Colloid | 44 (62.9%) | 15 (53.6%) | 29 (69.0%) | 0.189 |
Lactated Ringer’s | 23 (32.9%) | 11 (39.3%) | 12 (28.6%) | 0.350 |
Acetated Ringer’s | 50 (71.4%) | 20 (71.4%) | 30 (71.4%) | 1.000 |
Others | 20 (28.6%) | 12 (42.9%) | 8 (19.0%) | 0.031 |
Colloid solutions | ||||
HES | 25 (35.7%) | 7 (25.0%) | 18 (42.9%) | 0.127 |
Albumin | 69 (98.6%) | 27 (96.4%) | 42 (100%) | 0.400 |
Plasma | 58 (82.9%) | 23 (82.1%) | 35 (83.3%) | 1.000 |
Intake and output volume(ml) | ||||
> + 1000 | 1 (1.4%) | 0 (0.0%) | 1 (2.4%) | 1.000 |
+ 500 ~ + 1000 | 12 (17.1%) | 6 (21.4%) | 6 (14.3%) | 0.524 |
– 500 ~ + 500 | 45 (64.3%) | 19 (67.9%) | 26 (61.9%) | 0.611 |
– 500 ~ – 1000 | 21 (30.0%) | 7 (25.0%) | 14 (33.3%) | 0.456 |
<-1000 | 0 (0.0%) | 0 (0.0%) | 0 (0.0%) | |
Coagulation monitoring | ||||
None | 6 (8.6%) | 5 (17.9%) | 1 (2.4%) | 0.034 |
Activated clotting time test | 52 (74.3%) | 19 (67.9%) | 33 (78.6%) | 0.315 |
Thrombelastogram | 40 (57.1%) | 17 (60.7%) | 23 (54.8%) | 0.622 |
Platelet function analysis | 8 (11.4%) | 4 (14.3%) | 4 (9.5%) | 0.705 |
Traditional coagulation tests | 23 (32.9%) | 4 (14.3%) | 19 (45.2%) | 0.016 |
One-lung ventilation strategy | ||||
Double lumen endotracheal intubation | 70 (100.0%) | 28 (100.0%) | 42 (100.0%) | |
Bronchial blocker | 6 (8.6%) | 3 (10.7%) | 3 (7.1%) | 0.677 |
Ventilation mode | ||||
Pressure controlled | 67 (95.7%) | 27 (96.4%) | 40 (95.2%) | 1.000 |
Volume controlled | 36 (51.4%) | 12 (42.9%) | 24 (57.1%) | 0.241 |
PEEP after pulmonary artery opening(cmH2O) | 0.272 | |||
0 | 1 (1.4%) | 1 (3.6%) | 0 (0.0%) | |
1–5 | 13 (18.6%) | 5 (17.9%) | 8 (19.0%) | |
6–10 | 54 (77.1%) | 22 (78.6%) | 22 (76.2%) | |
> 10 | 2 (2.9%) | 0 (0.0%) | 2 (4.8%) | |
Tidal volume after pulmonary artery opening(mL/kg) | 0.272 | |||
< 4 | 7 (10.0%) | 3 (10.7%) | 4 (9.5%) | |
4–6 | 48 (68.6%) | 22 (78.6%) | 26 (61.9%) | |
6–8 | 14 (20.0%) | 3 (10.7%) | 11 (26.2%) | |
> 8 | 1 (1.4%) | 0 (0.0%) | 1 (2.4%) | |
Maximum peak inspiratory pressure(cmH2O) | 0.114 | |||
< 25 | 5 (7.1%) | 2 (7.1%) | 3 (7.1%) | |
25–30 | 30 (42.9%) | 16 (57.1%) | 14 (33.3%) | |
30–35 | 22 (31.4%) | 4 (14.3%) | 18 (42.9%) | |
> 35 | 13 (18.6%) | 6 (21.4%) | 7 (16.7%) | |
Vasoactive drugs | ||||
Metaraminol | 33 (47.1%) | 15 (53.6%) | 18 (42.9%) | 0.379 |
Phenylephrine | 47 (67.1%) | 17 (60.7%) | 30 (71.4%) | 0.350 |
Norepinephrine | 67 (95.7%) | 27 (96.4%) | 40 (95.2%) | 1.000 |
Methoxamine | 15 (21.4%) | 7 (25.0%) | 8 (19.0%) | 0.552 |
Ephedrine | 26 (37.1%) | 11 (39.3%) | 15 (35.7%) | 0.762 |
Vasopressin | 14 (20.0%) | 5 (17.9%) | 9 (21.4%) | 0.714 |
Epinephrine | 44 (62.9%) | 19 (67.9%) | 25 (59.5%) | 0.480 |
Dopamine | 26 (37.1%) | 12 (42.9%) | 14 (33.3%) | 0.419 |
Others | 8 (11.4%) | 1 (3.6%) | 7 (16.7%) | 0.103 |
Strategies to pulmonary arterial hypertension | ||||
Inhaled nitricoxide | 23 (32.9%) | 6 (21.4%) | 17 (40.5%) | 0.096 |
Inhaled prostanoids | 11 (15.7%) | 2 (7.1%) | 9 (21.4%) | 0.180 |
Intravenous milrinone | 45 (64.3%) | 19 (67.9%) | 26 (61.9%) | 0.611 |
Intravenous prostanoids | 42 (60.0%) | 15 (53.6%) | 27 (64.3%) | 0.370 |
Others | 11 (15.7%) | 6 (21.4%) | 5 (11.9%) | 0.328 |
Hemodynamic monitoring | ||||
SwanGanz catheter | 65 (92.9%) | 27 (96.4%) | 38 (90.5%) | 0.641 |
Calibrated pulse contour analysis | 55 (78.6%) | 18 (64.3%) | 37 (88.1%) | 0.017 |
Uncalibrated pulse contour analysis | 56 (80.0%) | 24 (85.7%) | 32 (76.2%) | 0.329 |
TEE | 47 (67.1%) | 24 (85.7%) | 23 (54.8%) | 0.007 |
Others | 3 (4.3%) | 1 (3.6%) | 2 (4.8%) | 1.000 |
TEE in lung transplantations | 0.511 | |||
All | 12 (17.1%) | 6 (21.4%) | 6 (14.3%) | |
Majority | 10 (14.3%) | 5 (17.9%) | 5 (11.9%) | |
About half | 4 (5.7%) | 2 (7.1%) | 2 (4.8%) | |
Minority | 29 (41.4%) | 8 (28.6%) | 21 (50.0%) | |
None | 15 (21.4%) | 7 (25.0%) | 8 (19.0%) | |
Postoperative analgesia | ||||
PCIA | 64 (91.4%) | 24 (85.7%) | 40 (95.2%) | 0.209 |
Regional nerve block | 57 (81.4%) | 24 (85.7%) | 33 (78.6%) | 0.452 |
PCEA | 2 (2.9%) | 0 (0.0%) | 2 (4.8%) | 0.513 |
Others | 4 (5.7%) | 1 (3.6%) | 3 (7.1%) | 0.645 |
