Ex-vivo lung perfusion Purpose of review Ex-vivo lung perfusion (EVLP) has been developed to expand the donor pool for lung transplantation recipients. The role of EVLP in organ preservation, evaluation and potential reconditioning is reviewed. Recent findings EVLP has been shown to significantly increase the utilization of donor lungs for transplantation. Evidence suggests that patient outcomes from EVLP lungs are comparable to standard procurement technique. Novel strategies are being developed to treat and recondition injured donor lungs. EVLP may also prove to be a tool for translational research of lung diseases. Summary EVLP has been shown to be an effective system to expand donor pool for lung transplantation without detriment to recipients. Future potential ex-vivo developments may further improve patient outcomes as well as increasing availability of donor organs. Correspondence to Jacobo Moreno Garijo, Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada. Tel.: +1 416 340 5164;. e-mail: jacobo.moreno@uhn.ca Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Anesthetic management of lung transplantation: impact of presenting disease Purpose of review Recent literature has described the emerging role of anesthesiologists as key members of the lung transplantation team and the impact of anesthetic management on outcomes. This review examines the impact of presenting cause of end-stage lung disease (ESLD) on anesthetic management. Recent findings The four primary causes of ESLD are suppurative, obstructive, or restrictive processes, and pulmonary hypertension. Our recent review of perioperative literature revealed new data regarding preoperative risk stratification, intraoperative management, and postoperative use of extracorporeal membrane oxygenation (ECMO) support. Major studies specifically about anesthetic management are lacking; however, the principles studied are readily applicable to the design of a perioperative care plan. The most compelling data have resulted in a revolutionary change in terms of intraoperative support and postoperative planning for pulmonary hypertension patients. Historically treated with cardiopulmonary bypass, significant data have been reported describing the successful use of ECMO both as an intraoperative support with superior outcomes, as well as postoperative support for improved stability during biventricular remodeling postgraft implantation. Summary The application of these updated findings should assist anesthesiologists as they develop internal protocols and external guidelines to integrate within multidisciplinary teams caring for the lung transplant patient. Correspondence to Archer Kilbourne Martin, MD, Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel.: +1 904 956 3004;. e-mail: Martin.Archer@Mayo.edu Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

Fascial plane blocks in thoracic surgery: a new era or plain painful? Purpose of review The demand for well-tolerated, effective, and opioid reducing pain management has become imperative in thoracic surgery. With the recent movement away from neuraxial analgesia for thoracic surgical patients, great interest in alternative analgesic techniques of the chest wall has developed. Several fascial plane blocks exist for pain management of the lateral chest wall and we present an up-to-date review of these popular new blocks. Recent findings The pectoralis and serratus anterior plane blocks may offer effective analgesia of the lateral chest wall for thoracic surgical patients. The erector spinae plane block may offer more extensive analgesic coverage but requires further investigation. Summary Fascial plane blocks hold the potential for well-tolerated and effective analgesia for thoracic surgical patients as part of a multimodal regimen of pain relief. However, many questions remain regarding block characteristics. As the literature matures, more formal recommendations will be made but quality trials are needed to provide this guidance. Correspondence to Donn Marciniak, MD. E-mail: marcind@ccf.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

From the ICU to the operating room: how to manage the patient? Purpose of review To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport. Recent findings Optimization entails glycemic control for all, with specific attention to type-1 diabetic patients. Transport-related adverse events may be averted with surgery in the ICU. If moving the patient is unavoidable, transport guidelines should be followed and hemodynamic optimization, airway control, and stabilization of mechanical ventilation ensured before transport. Preinduction preparation includes assessment of the airway and high-flow oxygen to prolong apneic oxygenation. Postintubation, a protective positive ventilation strategy, should be employed. Ideal transfusion thresholds are 7 g/dl for hemodynamically stable adult patients, 8 g/dl in orthopedic/cardiac surgery/cardiovascular disease and higher in specific disease states. Antimicrobial prophylaxis within 120 min of incision prevents most surgical site infections. Antibiotic therapy depends on the antibiotics being received in the ICU, the time elapsed since ICU admission, local epidemiology and the type of surgery. Tailored antimicrobial regimens may be continued periprocedurally. If more than 70% of the nutritional requirement cannot be met enterally, parenteral nutrition should be initiated within 5–7 days of surgery or earlier if the patient is malnourished. Summary ICU patients who require surgery may benefit from appropriate perioperative management. Correspondence to Professor Sharon Einav, MSc, MD, Director, Surgical Intensive Care Unit, Shaare Zedek Medical Centre, Affiliated with the Hebrew University, POB 3235, Jerusalem 91031, Israel. Tel: +972 2 6666664; fax: +972 2 6555144; e-mail: einav_s@szmc.org.il Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.