title: Perioperative management of carinal pneumonectomy: a retrospective review of 13 patients.
abstract: Carinal pneumonectomy is a challenging procedure because of the difficulties in surgical technique, intraoperative airway management, and postoperative respiratory and anastomotic complications. However, information regarding the anesthetic and intraoperative respiratory management of this procedure is scarce. This report describes our routine anesthetic and respiratory management strategy in patients undergoing carinal pneumonectomy. Medical records of 13 patients who underwent carinal pneumonectomy under combined general and epidural anesthesia between 2008 and 2012 were analyzed retrospectively. Eleven patients underwent right carinal pneumonectomy and two underwent left carinal pneumonectomy. A left double-lumen tube was used in all but one case, in which endobronchial intubation was difficult because of intrabronchial invasion of the tumor. A 6.0-mm-long reinforced endobronchial tube was intubated into the main bronchus of the non-operative side from the surgical field during carinal resection. There were no episodes of severe hypoxemia or hypercapnia during surgery. Twelve patients were extubated immediately after surgery. No patient developed post-thoracotomy acute lung injury or required postoperative reintubation despite poor preoperative respiratory function. The 30-day mortality rate was 0%. Our airway management protocol for carinal pneumonectomy enables positive surgical outcomes.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-11-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. ikawago@juntendo.ac.jp.
authors.forename: Izumi
authors.initials: I
authors.lastname: Kawagoe
authors.affiliation: Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-11-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Inada
authors.affiliation: Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Ishikawa
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shiaki
authors.initials: S
authors.lastname: Oh
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D001980:Bronchi; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods*; D014132:Trachea