Heart transplant

Heart transplant

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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Provide a brief summary of this surgical procedure and its indications here.

Preoperative management

Patient evaluation

System	Considerations
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Intraoperative management

All are General Recommendations and Considerations. Your comfortability, Surgeons, and hospital policies and practices will dictate the plan.

Monitoring and access

Large bore IV (18-gauge) placed in Pre-op. Can use this IV line to go to induce anesthesia and give pre-op medications.

Arterial Access:

Awake vs asleep Arterial Line, typically a radial arterial line. Surgeons may elect to place femoral arterial lines as well.

Vascular Access:

Once asleep: additional large bore access should be obtained: there is variation in practice here:

• Double Stick right Internal Jugular
  • Cordis 8.5F for large volume resuscitation and blood products
  • Single or double lumen 16g Central line for infusions
• Single Stick RIJ
  • Cordis 8.5F or 9F
  • 14 G or 16 G peripheral IV's
• Consider Triple stick, RIC line and additional access, especially for redo-sternotomy cases

Central monitoring:

• CVP monitoring
• Swan-ganz catheter placement is not unusual
  • Occasionally may be placed after induction but left at only 20cm until the new heart is placed in the chest then floated into the Pulmonary Artery.
  • Can be used to measure Cardiac Output and Cardiac index via Thermodilution

Positioning

Typically Supine with bilateral Arms tucked at the side.

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications