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.
Ferrandière
Martine
M
Department of Anesthesia and Critical Care, Regional University Hospital Center of Tours, Tours, France. ferrandiere@med.univ-tours.fr
Hazouard
Eric
E
Ayoub
Jean
J
Laffon
Marc
M
Gage
John
J
Mercier
Colette
C
Fusciardi
Jacques
J
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