Summary of perioperative analgesia and sedation management of 19 lung transplant recipients

Objective: To summarize and explore the management experience of postoperative analgesia and sedation in lung transplant recipients. Methods: A total of 19 cases of lung transplantation were performed in Renmin Hospital of Wuhan University from December 2016 to December 2020, and all of them were transferred back to intensive care unit after surgery, the clinical data were retrospectively analyzed. Results: Among the 19 patients, the main diagnoses were chronic obstructive pulmonary disease in 5 cases, idiopathic pulmonary fibrosis in 6 cases, bronchiectasis in 2 cases, pneumoconiosis in 4 cases, Kartagener syndrome in 1 case and COVID-19 pneumonia with advanced pulmonary fibrosis in 1 case. There were 12 cases of double lung transplantation, and 7 cases of unilateral lung transplantation in (4 cases of left single lung transplantation and 3 cases of right single lung transplantation). Nine patients used ECMO to complete the operation, and 5 cases took ECMO back to the intensive care unit. All patients were treated with opioid analgesia, mainly sufentanil at a dose of 0.2-0.3 μg/(kg•h), midazolam and propofol are mainly used as sedatives at doses of 0.02-0.1 mg/(kg•h) and 0.3-0.4 mg/(kg•h), respectively, and the Richmond agitation sedation scale was -3.01±1.32 within 24 hours after operation. The main postoperative adverse events were delirium (1 case) and respiratory depression (1 case). There were 6 deaths during the perioperative period. One case died of multi-drug resistant bacteria infection, 1 case died of circulatory failure caused by active thoracic hemorrhage post-operation, the third case died of intraoperative cardiac arrest, and the other 3 cases were given up because of multiple organs failure. Conclusion: Analgesia and sedation is an important treatment for patients after lung transplantation. Choosing the depth of sedation according to the functional state of organs of lung transplant recipients and implementing the sedation strategy aiming at organ function protection is helpful to maintain the stability of cardiopulmonary function after lung transplantation. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.