Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia.
OBJECTIVE
To document and explain the beneficial effects of non-invasive ventilation in correcting hypoxemia and hypoventilation in severe chronic obstructive pulmonary disease, during spinal anesthesia in the lithotomy position.


METHODS
A morbidly obese patient with severe chronic obstructive pulmonary disease underwent prostate surgery in the lithotomy position under spinal anesthesia. Hypoxemia was encountered during surgery, and a profound decrease of forced vital capacity associated with alveolar hypoventilation and ventilation/perfusion mismatching were observed. In the operating room, an M-mode sonographic study of the right diaphragm was performed, which confirmed that after spinal anesthesia and assuming the lithotomy position, there was a large decrease (-30%) in diaphragmatic excursion. Hypoxemia and alveolar hypoventilation were successfully treated with non-invasive positive pressure ventilation.


CONCLUSIONS
Intraoperative application of non-invasive positive pressure ventilation improved diaphragmatic excursion and overall respiratory function, and reduced clinical discomfort in this patient.
Department of Anesthesia and Critical Care, Regional University Hospital Center of Tours, Tours, France. ferrandiere@med.univ-tours.fr
Martine
M
Ferrandière
Eric
E
Hazouard
Jean
J
Ayoub
Marc
M
Laffon
John
J
Gage
Colette
C
Mercier
Jacques
J
Fusciardi
D000775:Anesthesia, Spinal; D003964:Diaphragm / Q000000981:diagnostic imaging; D006801:Humans; D007040:Hypoventilation / Q000150:complications / Q000628:therapy*; D000860:Hypoxia / Q000628:therapy; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011175:Positive-Pressure Respiration / Q000379:methods*; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D014463:Ultrasonography