Acute life-threatening intraoperative atelectasis.
A case is presented of acute intraoperative atelectasis causing profound hypoxaemia in a patient undergoing a combined epidural-general anaesthetic for hip surgery in the lateral position. The pathophysiology of the resultant ventilation-perfusion mismatch and the effects of applied positive end-expiratory pressure in the lateral position are explored. The emergency management is assessed, with emphasis on the role of bronchoscopy in diagnosis and treatment of this rare cause of life-threatening hypoxaemia in the operating room. This patient with risk factors for respiratory complications may have benefited from preoperative bronchoscopy to assist in lung expansion.
Pivalizza
E G
EG
Department of Anesthesiology, University of Texas Medical School at Houston 77030.
Tonnesen
A S
AS
D000077:Acetabulum / Q000293:injuries; D000208:Acute Disease; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D001999:Bronchoscopy; D003965:Diaphragmatic Eventration / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D007385:Intermittent Positive-Pressure Ventilation; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D001261:Pulmonary Atelectasis / Q000209:etiology*; D014692:Ventilation-Perfusion Ratio