Thoracic epidural anesthesia for a polymyositis patient undergoing awake mini-thoracotomy and unroofing of a huge pulmonary bulla.
General anesthesia with one-lung ventilation is a conventional anesthetic strategy for most chest surgery, including resection of pulmonary bullae. However, this anesthetic management may cause alveolar barotrauma, hemodynamic instability, pulmonary atelectasis and long-term ventilator dependency. Here, we report a 64-year-old female with polymyositis and bronchiolitis obliterans organizing pneumonia who was scheduled for surgical intervention for a huge pulmonary bulla over the right upper lung. Under thoracic epidural anesthesia, with the patient maintaining clear consciousness and spontaneous breathing, a mini-thoracotomy was accomplished to unroof and partially resect the bulla. There were no perioperative complications, and the patient was satisfied with the anesthetic care. Pulmonary function tests and daily physical performance also improved postoperatively.
Yen
Chia-Rong
CR
Department of Anesthesiology, Taipei Veterans General Hospital, and National Yang-Ming University, No. 201 Section 2 Shih-Pai Road, Taipei, Taiwan, R.O.C.
Tsou
Mei-Yung
MY
Lin
Su-Man
SM
Chan
Kwok-Hon
KH
Chu
Ya-Chun
YC
D000767:Anesthesia, Epidural / Q000379:methods*; D001768:Blister / Q000601:surgery*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000601:surgery*; D008875:Middle Aged; D017285:Polymyositis / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D014851:Wakefulness