Akademik Veri Yönetim Sistemi
Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi, cilt.9, sa.2, ss.89-93, 2003 (Scopus)
Patients undergoing specific thoracic procedures require close observation during anaesthesia. In this case report, we describe the anaesthetic management of a patient for resection of a giant pulmonary air cyst occupying 2/3 of his left thoracic cavity. A 38 yr-old male (ASA physical status III) was scheduled to undergo thoracic surgery. He was complaining of orthopnea preoperatively. His chest X-ray and CT scan showed a giant air cyst of the left lung and bilateral multiple air cysts of both lungs. The forced expiratory volume in 1 sec (FEV1) was low (1.19 L, % 34) preoperatively. We induced anaesthesia with thiopental and fentanyl. Intubation was performed with left-sided double lumen endobronchial tube after vecuronium administration. We maintained anaesthesia with isoflurane and oxygen in air. The tidal volume using volume-cycled ventilation was adjusted to maintain peak airway pressure to a maximum of 20 cm H2O during two-lung ventilation and to a maximum of 30 cm H2O during one-lung ventilation. After resection of the cyst, intercostal nerve blockade was achieved with bupivacaine. At the end of the surgery, the trachea was extubated following administration of the reversal agent. Assisted ventilation by mask was applied for preventing atelectasis. The patient was transferred to the cardiothoracic intensive care unit after analysing the arterial blood gases. Pethidine HCl and diclofenac sodium were ordered for postoperative analgesia. Intraoperatively observed moderate hypercapnia persisted during the early postoperative period. PaCO2 decreased below the preoperative value within the 1st postoperative day after anaesthetic recovery and adequate analgesia were maintained. The patient's postoperative course was otherwise uneventful. He was discharged from the hospital on the 7th postoperative day. Tension pneumothorax was considered as one of the serious complications of mechanical ventilation during the anaesthetic management of our patient. There are several strategies that limit the risk of barotrauma in such patients during general anaesthesia. Protective measures such as low tidal volume ventilation (permissive hypercapnia) and immediate postoperative extubation were effective for a safe anaesthetic management of our patient.