[Anesthetic management for a patient with postural hypoxemia].
Postural hypoxemia is rare in patients with no organic cardio-pulmonary diseases. This is caused by closure of the airway in the dorsal area at functional residual capacity in patients on supine position, and may cause difficulty or inability in management of induction and maintenance of general anesthesia. A 69-year-old patient (BMI 28.6) was scheduled for subtotal gastrectomy. After epidural catheter insertion at T 10-11, general anesthesia was induced by thiamylal sodium followed by paralyzing dose of vecuronium bromide, and the trachea was intubated. Anesthesia was maintained with continuous epidural administration of bupivacaine, inhalation of sevoflurane and nitrous oxide in oxygen and intravenous vecuronium bromide. Patients were mechanically ventilated with pressure limit of 19-20 cmH2O, a respiratory rate of 8 breaths per minutes, and a fresh gas flow rate of 2.5 l x min(-1). Respiratory mechanics were measured with a Capnomac Ultima anesthetic gas analyzer and a side-stream spirometry device (Datex instrumentarium Corp., Helsinki, Finland). We found that expiratory tidal volume and thorax-lung compliance decreased with increased PETCO2 on supine position and transabdominal cephalad retraction of the liver. We tried to maintain the alveolar recruitments by PEEP and higher thorax-lung compliance by the Fowler position. These procedures exerted favourable effects on respiratory mechanics of this patient.
Matsumoto
Kappei
K
Department of Anesthesiology, Higashi-Yamato Hospital.
Shimizu
Kenichi
K
D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D005652:Functional Residual Capacity; D005743:Gastrectomy; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology*; D008170:Lung Compliance / Q000502:physiology*; D008875:Middle Aged; D011187:Posture; D015656:Respiratory Mechanics