The One-Eyed Patient

A 78-yr-old female is scheduled for a right upper lobectomy under general anesthesia. She is 54 kg and 5′10″ tall. Her weight has been steady for as long as she can remember. Her history is significant for hypertension, a 50-yr smoking history, and an enucleation of the right eye for tumor 10yr ago. She is unsure what the tumor was. She has a glass eye, but prefers to wear a large black eye patch that covers the whole orbit, including the eyebrow. Otherwise, her medical history and physical exam are unremarkable. She has a class 2 airway. After sedation with midazolam 1 mg IV, she is taken to the operating room where a routine general anesthetic, with fentanyl, thiopental, and vecuronium, is induced uneventfully. Mask ventilation with sevoflurane in 100% oxygen proves to be difficult, as there is a large leak detected around her face. A larger and well-inflated facemask is placed over her mouth and nose, but a large leak is still present. By increasing the fresh gas flow to 12 liters, the patient is easy to ventilate, but the leak is still present and everyone in the room can smell the sevoflurane. You again perform a pressure leak test on the anesthetic absorber circuit (you did it before you started), but you find nothing wrong. Another anesthesiologist is brought in to hold the mask with both hands while you elect to ventilate the patient with the reservoir bag. Despite this the leak is still there. Her vital signs remain stable, but you are concerned, as this unexplained leak is something you have not encountered before. What will you do now?


Operating Room Vital Sign Tracheal Intubation Physical Exam Lung Pathology 
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  1. 1.
    Brock-Utne JG. Beware of the patient with an eye patch. Anesth Analg. 2007;104:1615.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2008

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