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Canadian Journal of Anesthesia

, Volume 52, Issue 9, pp 986–989 | Cite as

Lung mechanics and gas exchange in one-lung ventilation following contralateral resection

  • Pedro Ruiz
  • Garrett Kovarik
Article

Abstract

Purpose

To describe the anesthetic management of a patient with previous left lower lobe resection who was submitted to a right upper lobectomy and review the changes in gas exchange and respiratory mechanics which occurred intraoperatively.

Clinical features

A 69-yr-old male with lung cancer, emphysema and obstructive sleep apnea, presented for a right upper lobectomy. His history was also positive for a left lower lobectomy six years previously. Intraoperative lung isolation was achieved using a 41 F left double-lumen tube (DLT). Monitoring the respiratory mechanics allowed for continuous adjustment of ventilator settings during the various phases of the surgery avoiding the risks of barotrauma and volutrauma. Problems with oxygenation occurred during one-lung ventilation.

Conclusion

This case report shows that a severe level of hypoxemia and hypercarbia associated to lung mechanical property changes can be observed during the OLV phase. Application of continuous positive airway pressure on the non-dependent lung partially corrected blood oxygenation. Lobe isolation techniques should be considered as useful options for intraoperative airway management for these patients.

Keywords

Obstructive Sleep Apnea Continuous Positive Airway Pressure Lung Resection Respiratory Mechanic Plateau Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

La mécanique respiratoire et les échanges gazeux pendant la ventilation unilatérale suivant une résection controlatérale

Résumé

Objectif

Décrire l’anesthésie d’un patient, ayant déjà subi la résection du lobe inférieur gauche, qui a été soumis à une lobectomie supérieure droite et revoir les changements peropératoires survenus dans les échanges gazeux et la mécanique respiratoire.

Éléments cliniques

Un homme de 69 ans, atteint de cancer du poumon, d’emphysème et d’apnée du sommeil, devait subir une lobectomie supérieure droite. L’isolement pulmonaire peropératoire a été réalisé à l’aide d’un tube 41 Fà double lumière gauche (TDL). Le monitorage de la mécanique respiratoire a permis le réglage continu des paramètres ventilatoires peropératoires et d’éviter les risques de barotrauma et de volutrauma. L’oxygénation a été problématique pendant la ventilation unilatérale (VUL).

Conclusion

Un niveau élevé d’hypoxémie et d’hypercapnie associé à des changements dans les propriétés mécaniques pulmonaires peut être observé pendant la VUL. La ventilation à pression positive constante du poumon non déclive a corrigé partiellement l’oxygénation sanguine. Les techniques d’isolement pulmonaire doivent être envisagées pour la prise en charge peropératoire des voies respiratoires de ce type de patients.

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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  1. 1.Department of Anesthesia, Montreal General HospitalMcGill University Health CentreMontréalCanada

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