title: Anesthetic management of patients undergoing unilateral video-assisted lung reduction for treatment of end-stage emphysema.
abstract: OBJECTIVE
  Nonanatomic resection of peripheral areas of lung is being performed via sternotomy for the treatment of end-stage emphysema. Recent technologic advances have allowed the resection of lung tissue using video-assisted thoracic surgery (VATS) techniques. The study was performed to document the physiologic changes that occur during unilateral VATS lung reduction in hopes of determining appropriate monitoring and intraoperative management strategies.
  
  
  METHODS
  Prospective trial of unilateral VATS lung reduction.
  
  
  METHODS
  Tertiary care university hospital.
  
  
  METHODS
  Twenty patients with end-stage emphysema.
  
  
  METHODS
  Participants underwent unilateral VATS lung reduction.
  
  
  RESULTS
  Invasive hemodynamic monitoring was performed using radial and pulmonary artery catheters. Hemodynamic and respiratory gas exchange data were collected at four intraoperative points: (1) supine, two-lung ventilation; (2) lateral decubitus, two-lung ventilation; (3) lateral decubitus, one-lung ventilation, and (4) end of surgery, supine, two-lung ventilation. Data were compared with that collected at the first point. Patients tolerated lengthy surgical procedures and remained hemodynamically stable with no episodes of hypoxemia requiring treatment. Extubation was tolerated by 19 of 20 patients at the conclusion of surgery without further requirement of mechanical ventilation.
  
  
  CONCLUSIONS
  VATS lung reduction under general anesthesia with one-lung ventilation is well tolerated. Permissive hypercapnia was well tolerated by all patients. Early extubation can be routinely accomplished in these patients.
authors.affiliation: Department of Anesthesiology, Saint Louis University Health Sciences, MO 63110-0250, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Krucylak
authors.forename: K S
authors.initials: KS
authors.lastname: Naunheim
authors.forename: C A
authors.initials: CA
authors.lastname: Keller
authors.forename: L J
authors.initials: LJ
authors.lastname: Baudendistel
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000601:surgery*; D012121:Respiration, Artificial