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Anesthetic management for double lung transplantation in an 8-year-old male with extreme malnutrition (BMI 11.4 kg/m2) following hematopoietic stem cell transplantation: a case report

   
@article{TP154188,
	author = {Lifang Zhang and Rongqing Gao and Xue Li and Min Yan},
	title = {Anesthetic management for double lung transplantation in an 8-year-old male with extreme malnutrition (BMI 11.4 kg/m2) following hematopoietic stem cell transplantation: a case report},
	journal = {Translational Pediatrics},
	volume = {15},
	number = {6},
	year = {2026},
	keywords = {},
	abstract = {Background: Severe malnutrition is a prevalent comorbidity in pediatric lung transplantation (LTx) and is historically considered as a relative contraindication due to high perioperative mortality. While current guidelines emphasize the hazards of a low body mass index (BMI), literature detailing specific anesthetic strategies for severely malnourished patients remains limited. This report delineates an anesthetic protocol designed to safely navigate a candidate with an extremely low BMI through surgical stress, demonstrating the clinical value of precision management over rigid anthropometric cutoffs.Case Description: An 8-year-old male with end-stage bronchiolitis obliterans syndrome (BOS) following hematopoietic stem cell transplantation (HSCT) presented for double LTx. The chief complaint was progressive chest tightness and dyspnea for 11 months, 3 years post HSCT. He exhibited profound somatic depletion with an extremely low BMI of 11.4 kg/m2. The anesthetic strategy aimed to mitigate the dual risks of altered pharmacokinetics and limited myocardial reserve. Bispectral index (BIS) monitoring was utilized for the precise anesthetic depth titration, preventing the relative overdose and drug accumulation common in sarcopenic patients. Intraoperatively, profound hypotension and bradycardia occurred during pulmonary artery (PA) and left atrial clamping. This critical hemodynamic intolerance was successfully managed via transesophageal echocardiography (TEE)-guided optimization and vasopressor support. The patient was extubated on postoperative day 2 and discharged from the intensive care unit (ICU) on day 6, demonstrating favorable long-term pulmonary function and catch-up growth.Conclusions: Successfully navigating pediatric LTx in cases of extreme malnutrition (BMI },
	issn = {2224-4344},	url = {https://tp.amegroups.org/article/view/154188}
}