[A case of anesthetic management for re-expansion pulmonary edema of the dependent lung saved by superimposed HFJV during one lung ventilation for the thoracoscopic operation associated with bilateral pneumothorax].
A 21-year-old male with bilateral pneumothorax underwent thoracoscopic bullaectomy in the lateral decubitus position. General anesthesia was induced using thiopental 250 mg and suxamethonium 80 mg and maintained using the combination of the thoracic-epidural anesthesia with assisted spontaneous respiration. He was intubated with a tube equipped with mobile bronchial cuff. On the left bullaectomy, two lung ventilation (TLV) was applied and its course was uneventful. On the right, one lung ventilation (OLV) was done. Fifty minutes after the start of OLV of the left lung, percutaneous arterial hemoglobin saturation (SpO2) declined to 60% with PaO2 36 mmHg. Then, under super imposed HFJV (high frequency jet ventilation) added to manual assisted ventilation through the bronchial brocker, SpO2 increased rapidly to 100%. Postoperative chest X-p showed signs of re-expansion pulmonary edema (RPE) in the dependent, left lung. PaO2 after 25 minutes of hypoxic episode increased to 339.2 mmHg. About 2 hours later he was extubated uneventfully. We conclude that superimposed HFJV is very beneficial for treatment of the RPE of the dependent lung during OLV applied for thoracoscopic operation with bilateral pneumothorax.
Wake
M
M
Department of Anesthesia, St. Mary's Hospital, Himeji.
Sanagawa
Y
Y
Okamoto
Y
Y
D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D006611:High-Frequency Jet Ventilation; D006801:Humans; D008297:Male; D011030:Pneumothorax / Q000601:surgery*; D011183:Postoperative Complications / Q000628:therapy*; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods; D013906:Thoracoscopy