Troubleshooting One-Lung Ventilation
Despite more reliable methods to ensure lung isolation, hypoxia during one-lung ventilation (OLV) can still be a challenge for the anesthesiologist. While a true lower acceptable limit of saturation has not been defined, and is likely different for different patients, cerebral oxygenation does fall significantly during thoracic anesthesia cases, and decreased cerebral oxygenation has been associated with adverse outcomes. Different management strategies can be employed to prevent and treat hypoxia during OLV. These include optimal ventilatory management of the dependent lung, techniques to deliver oxygen to the non-ventilated lung, regulation of physiologic parameters such as circulation, and control of pharmacological factors. This chapter will also cover the issue of the inadequately deflating lung that the anesthesiologist may have to deal with from time to time. A case discussion will follow.
KeywordsOne-lung ventilation Hypoxia Thoracic anesthesia Lung isolation Collapse
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