Abstract
It is challenging to establish one-lung ventilation in difficult airway patients. Surgical pneumothorax under spontaneous breathing to obtain well-collapsed lung is a feasible method for thoracic surgery. A 76-year-old man with right empyema was scheduled for decortication. The patient had limited mouth opening due to facial cellulitis extending from the left cheek to neck. Generally, lung isolation is achieved by double-lumen endotracheal tube or bronchial blocker. Double-lumen tube insertion is difficult for patients with limited mouth opening and right-side placement of bronchial blocker usually causes insufficient deflation. We introduce an alternative lung isolation technique by surgical pneumothorax under spontaneous breathing simply with an endotracheal tube placement. This technique has never been applied into the management of difficult one-lung ventilation. By this method, we provide an ideal surgical condition with safer, less time-consuming, and less skill-demanding anesthesia. It would be an alternative choice for management of one-lung ventilation in the difficult lung isolation patient.
Similar content being viewed by others
References
Brodsky JB. Lung separation and the difficult airway. Br J Anaesth. 2009;103(Suppl 1):i66–75.
Pompeo E, Tacconi F, Mineo D, Mineo TC. The role of awake video-assisted thoracoscopic surgery in spontaneous pneumothorax. J Thorac Cardiovasc Surg. 2007;133(3):786–90.
Chen JS, Cheng YJ, Hung MH, Tseng YD, Chen KC, Lee YC. Nonintubated thoracoscopic lobectomy for lung cancer. Ann Surg. 2011;254(6):1038–43.
Campos JH. Which device should be considered the best for lung isolation: double-lumen endotracheal tube versus bronchial blockers. Curr Opin Anaesthesiol. 2007;20:27–31.
Hung MH, Chan KC, Liu YJ, Hsu HH, Chen KC, Cheng YJ, Chen JS. Nonintubated thoracoscopic lobectomy for lung cancer using epidural anesthesia and intercostal blockade: a retrospective cohort study of 238 cases. Medicine. 2015;94(13):e727.
Benumof JL. One-lung ventilation and hypoxic pulmonary vasoconstriction: implications for anesthetic management. Anesth Analg. 1985;64(8):821–33.
David P, Pompeo E, Fabbi E, Dauri M. Surgical pneumothorax under spontaneous ventilation-effect on oxygenation and ventilation. Ann Transl Med. 2015;3(8):106.
Li TH, Rheinlander HF, Etsten B. Circulatory changes due to open pneumothorax in surgical patients. Anesthesiology. 1960;21:171–7.
Acknowledgments
We would like to thank our patient for giving the permission for publishing this case report.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Yeh, PH., Hsu, PK. An alternative method to achieve one-lung ventilation by surgical pneumothorax in difficult lung isolation patient: a case report. J Anesth 30, 328–330 (2016). https://doi.org/10.1007/s00540-015-2125-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-015-2125-6