Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade.
We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video-assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient's cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video-assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one-lung spontaneous ventilation in this high-risk patient, we successfully used non-invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non-invasive lung ventilation.
Guarracino
F
F
Division of Cardiothoracic Anaesthesia and Intensive Care, Cardio-Thoracic Department, University Hospital of Pisa, Via Paradisa 2, Pisa 56124, Italy. f.guarracino@ao-pisa.toscana.it
Gemignani
R
R
Pratesi
G
G
Melfi
F
F
Ambrosino
N
N
D000368:Aged; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local; D005260:Female; D006801:Humans; D008012:Lidocaine; D010166:Palliative Care / Q000379:methods*; D010490:Pericardial Effusion / Q000601:surgery; D016066:Pleural Effusion, Malignant / Q000601:surgery; D011175:Positive-Pressure Respiration / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014851:Wakefulness
D000779:Anesthetics, Local; D008012:Lidocaine