Anesthetic Management of a Cardiac Transplant Patient After Extensive Facial Trauma Caused by a Pit Bull Attack.

A 72-year-old male cardiac transplant patient presented after sustaining facial and extremity trauma caused by a pit bull dog attack. The case was further complicated by the duration of the surgery, bleeding, infection risk, intraoperative hypothermia, immunosuppression, and the risk of sepsis. His anesthetic management required careful coordination with his transplant team. We also sought the expertise of the in-house pharmacist to obtain the appropriate administration strategies for the patient's immunosuppressant agents. As the number of transplant patients increases, oral and maxillofacial surgeons must remain cognizant of the challenges and strategies associated with treating those undergoing graft-preserving immunosuppression. We have presented a more complex case of a cardiac transplant patient requiring extensive facial soft tissue reconstruction. The experience achieved in the management of a complex cardiac patient will no doubt provide guidance in the management of elective surgical procedures in other patients with simpler transplant histories.