title: Anaesthesia for serial whole-lung lavage in a patient with severe pulmonary alveolar proteinosis: a case report.
abstract: BACKGROUND
  Pulmonary alveolar proteinosis is a rare condition that requires treatment by whole-lung lavage. We report a case of severe pulmonary alveolar proteinosis and discuss a safe and effective strategy for the anaesthetic management of patients undergoing this complex procedure.
  
  
  METHODS
  A 34-year-old Caucasian man was diagnosed with severe pulmonary alveolar proteinosis. He developed severe respiratory failure and subsequently underwent serial whole-lung lavage. Our anaesthetic technique included the use of pre-oxygenation, complete lung separation with a left-sided double-lumen endotracheal tube, one-lung ventilation with positive end-expiratory pressure, appropriate ventilatory monitoring, cautious use of positional manoeuvres and single-lumen endotracheal tube exchange for short-term postoperative ventilation.
  
  
  CONCLUSIONS
  Patients with pulmonary alveolar proteinosis may present with severe respiratory failure and require urgent whole-lung lavage. We have described a safe and effective strategy for anaesthesia for whole-lung lavage. We recommend our anaesthetic technique for patients undergoing this complex and uncommon procedure.
authors.affiliation: Department of Anaesthesia & Intensive Care, Papworth Hospital, Cambridge, UK. stephentwebb@doctors.org.uk
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Webb
authors.forename: Adrian J R
authors.initials: AJ
authors.lastname: Evans
authors.forename: A James
authors.initials: AJ
authors.lastname: Varley
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Klein