Lung mechanics and gas exchange in one-lung ventilation following contralateral resection.
OBJECTIVE
To describe the anesthetic management of a patient with previous left lower lobe resection who was submitted to a right upper lobectomy and review the changes in gas exchange and respiratory mechanics which occurred intraoperatively.


METHODS
A 69-yr-old male with lung cancer, emphysema and obstructive sleep apnea, presented for a right upper lobectomy. His history was also positive for a left lower lobectomy six years previously. Intraoperative lung isolation was achieved using a 41 F left double-lumen tube (DLT). Monitoring the respiratory mechanics allowed for continuous adjustment of ventilator settings during the various phases of the surgery avoiding the risks of barotrauma and volutrauma. Problems with oxygenation occurred during one-lung ventilation.


CONCLUSIONS
This case report shows that a severe level of hypoxemia and hypercarbia associated to lung mechanical property changes can be observed during the OLV phase. Application of continuous positive airway pressure on the non-dependent lung partially corrected blood oxygenation. Lobe isolation techniques should be considered as useful options for intraoperative airway management for these patients.
Ruiz
Pedro
P
Department of Anesthesia, Montreal General Hospital, McGill University Health Centre, 1650, avenue Cedar, Room D10 165.3, Montréal, Québec H3G 1A4, Canada. ppruizmd@aol.com
Kovarik
Garrett
G
D000368:Aged; D001469:Barotrauma / Q000517:prevention & control; D004646:Emphysema / Q000150:complications / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia / Q000097:blood; D008168:Lung / Q000502:physiology* / Q000601:surgery*; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative; D010092:Oximetry; D011659:Pulmonary Gas Exchange / Q000502:physiology*; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000503:physiopathology