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Perioperative management of carinal pneumonectomy: a retrospective review of 13 patients

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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.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Juntendo University School of Medicine, 2-11-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Izumi Kawagoe & Eiichi Inada

  2. Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan

    Seiji Ishikawa

  3. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Takeshi Matsunaga, Kazuya Takamochi, Shiaki Oh & Kenji Suzuki

Authors
  1. Izumi Kawagoe
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  2. Eiichi Inada
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  3. Seiji Ishikawa
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  4. Takeshi Matsunaga
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  5. Kazuya Takamochi
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  6. Shiaki Oh
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  7. Kenji Suzuki
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Correspondence to Izumi Kawagoe.

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Kawagoe, I., Inada, E., Ishikawa, S. et al. Perioperative management of carinal pneumonectomy: a retrospective review of 13 patients. J Anesth 29, 446–449 (2015). https://doi.org/10.1007/s00540-014-1932-5

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  • DOI: https://doi.org/10.1007/s00540-014-1932-5

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