1/4. Anaesthetic considerations for lung volume reduction surgery--a case report.INTRODUCTION: This case describes some of the unique problems faced by the thoracic anaesthesiologists during anaesthesia for lung volume reduction surgery. CLINICAL PICTURE: The usual pulmonary function requirements for lobectomy are normally not met in these patients with severe emphysema. TREATMENT: maintenance of the functional residual capacity of the lung and normocapnia during anaesthesia are not as important. Instead problems due to barotrauma and dynamic hyperinflation from positive pressure ventilation are. OUTCOME: Modification of ventilation strategy and providing an anaesthetic tailored towards early extubation is the cornerstone of the anaesthetic plan. CONCLUSION: A good understanding of the respiratory physiology in patients with severe emphysema is essential.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. pregnancy and alpha-1 antitrypsin deficiency.A 29 year old patient with alpha-1 antitrypsin deficiency and bullous emphysema became pregnant against the advice of her physicians. Despite a mid-trimester pneumothorax requiring the insertion of a chest tube, she went on to deliver a healthy child under epidural anaesthesia using a midforceps technique. Vaginal delivery is not necessarily contra-indicated in multiparous patients with bullous emphysema.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |
3/4. Anaesthesia for the patient with a coincidental giant lung bulla: a case report.The anaesthetic management of a patient with a coincidental giant lung bulla who underwent lumbar discectomy and laminectomy is described. The specific problems associated with anaesthesia in patients wih bullae, such as acute enlargement or rupture of the bullae, are discussed. Precautionary measures which may be taken during anaesthesia include the avoidance of nitrous oxide, the prophylactic use of a double-lumen tube, and the immediate availability of chest drains in the anaesthetizing area. Monitoring during operation may involve bilateral chest auscultation and arterial blood gas analysis.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/4. Anaesthetic management of a patient with a descending thoracic aortic aneurysm and severe bilateral bullous pulmonary parenchymal disease.The anaesthetic management of the surgical repair of a descending aortic aneurysm in a patient with large, bilateral, pulmonary bullae is described. Anaesthesia for descending aortic surgery normally involves unilateral, positive-pressure ventilation, an option which poses some risk of barotrauma in the presence of bilateral bullae. patients with bullous disease commonly have severe lung disease and thorough preoperative assessment and preparation are necessary. Intraoperatively, bilateral rupture of the bullae could be catastrophic and preparations should be made for this possibility. In order to diminish this risk, a surgical technique including preemptive collapse of the bulla by minithoracotomy and tube drainage, with use of a bronchial blocker to the affected part of the lung may be used. If rupture occurs, then high frequency jet ventilation may be effective. Use of a double lumen endobronchial tube may be advantageous for patients with either unilateral and bilateral bullae. Anaesthesia for patients with bullae should avoid positive-pressure ventilation and nitrous oxide in order to limit the risk of barotrauma from a ball valve mechanism. In this case, the risk of barotrauma was reduced by performing an inhalational induction of anaesthesia and limiting peak inflation pressures during thoracotomy. It was elected to use positive-pressure ventilation through a double lumen endobronchial tube following chest incision. A high frequency jet ventilator was available but not employed. Anaesthetic management was complicated by the presence of pleural adhesions, surgical approach directly through a bulla, and the requirement for one lung ventilation.- - - - - - - - - - ranking = 0.5keywords = anaesthesia (Clic here for more details about this article) |