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.
Department of Anesthesiology, University of Texas Medical School at Houston 77030.
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Pivalizza
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Tonnesen
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