title: An uncommon procedure for a rare ailment: massive bronchoalveolar lavage in a patient with pulmonary alveolar proteinosis.
abstract: As a rare procedure, massive bronchoalveolar lavage (MBAL) is a large-volume lavage which necessitates general anesthesia and one-lung ventilation (OLV). During MBAL isotonic saline is instilled into one lung and drained through one lumen of a double-lumen tube. MBAL is the most effective treatment for symptomatic pulmonary alveolar proteinosis (PAP). A 27-year-old male with PAP was scheduled for therapeutic MBALs. After standard preoxygenation, monitoring and anesthesia induction, a double-lumen tube was placed. Tube position was verified by a fiberoptic bronchoscope. The internal jugular vein, radial and pulmonary arteries were cannulated. A temperature probe and foley catheter were inserted. The nonventilated lung was filled with 1000 mL saline and then drained in each session. The left and right lung were lavaged with an interval of 2 weeks. A total of 20 L saline was used in each MBAL without retention. MBALs were terminated after the effluent became clear. Duration of the left and right MBALs were 325 and 275 minutes, respectively. Despite increased shunt fraction, oxygenation was within acceptable limits during OLV. The trachea was extubated in the operating room uneventfully after each MBAL. The patient's clinical and laboratory findings were evidently improved. Consequently, if proper conditions are provided, MBAL is safe and beneficial despite its risks and the long duration.
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Hilal Günal
authors.initials: HG
authors.lastname: Sazak
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Saziye
authors.initials: S
authors.lastname: Sahin
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Polat
authors.initials: P
authors.lastname: Pehlivanoğlu
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Ozlem
authors.initials: O
authors.lastname: Cakır
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Mehtap
authors.initials: M
authors.lastname: Tunç
authors.affiliation: Department of Anesthesiology and Reanimation, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Fatma
authors.initials: F
authors.lastname: Ulus
authors.affiliation: Department of Chest Disease and Tuberculosis, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Behiye
authors.initials: B
authors.lastname: Akkalyoncu
authors.affiliation: Department of Chest Disease and Tuberculosis, Atatürk Chest Disease and Thoracic Surgery Education and Research Hospital, Ankara, Turkey.
authors.forename: Belgin
authors.initials: B
authors.lastname: Samurkaşoğlu
keywords: Bronchoalveolar lavage; general anesthesia; pulmonary alveolar proteinosis