Minimal access mediastinal surgery: One or two lung ventilation?
نویسندگان
چکیده
BACKGROUND Minimal access mediastinal surgery (MAMS) is usually performed under general anaesthesia with double lumen tubes (DLT). The aim of this study is to evaluate two lung ventilation through single lumen tubes (SLT) during thoracoscopic sympathectomy for hyperhidrosis and thoracoscopic thymectomy for myasthenia gravis. METHODS In this prospective non-randomized study, MAMS was performed in 58 patients with hyperhidrosis and 42 patients with myasthenia gravis, from January 2002 to December 2008. Patients were intubated with a DLT or SLT, 50 patients in each group. In the DLT group, endobronchial tubes were placed using the traditional blind approach and one lung ventilation was confirmed clinically. In the SLT group, the hemithorax was insufflated with CO2 in conjunction with two-lung anaesthesia. All the patients were evaluated for haemodynamic stability, oxygen saturation of haemoglobin (Spo2), end-tidal Pco2 (ETPco2), times required for intubation and surgery, satisfaction of surgeon with regard to exposure and postoperative complications. RESULTS In the SLT group, all the patients had stable haemodynamic and ventilation parameters. In the DLT group, haemodynamic instability occurred in two, decrease in Spo2 in four and increase in ETPco2 in three patients. One patient in the DLT group developed vocal cord granuloma two months later. Time required for surgery and the surgeon's opinion with regard to exposure were similar for both groups. CONCLUSION Thoracoscopic surgery when used in cases where a well-collapsed lung may not be essential, since surgery is not performed on the lung itself, does not require DLT. SLT is safe in MAMS. It provides good surgical exposure and decreases the cost, time and undesirable complications of DLT.
منابع مشابه
Anaesthesia for a patient undergoing transthoracic endoscopic vagotomy.
We describe the anaesthetic management of a patient who underwent transthoracic endoscopic vagotomy. One-lung ventilation was necessary to provide adequate surgical access. Potential intraoperative problems involved arterial oxygen saturation during one-lung ventilation, unequal intrathoracic pressures causing mediastinal displacement and inadvertent myocardial injury by surgical instruments an...
متن کاملOne-Lung Ventilation in a Patient with a Fresh Tracheostomy – A Case Report
After drainage of cervical abscesses, the tracheostomy was performed. For one-lung ventilation a wire guided endobronchial blocker (Arndt Blocker) was electively placed through the cannula of the fresh tracheostomy. The patient was submitted to one lung ventilation for 5 hours. Some episodes of hypoxemia required intermittent two lungs ventilation under 100% FiO2. The surgery lasted eight hours...
متن کاملVideo-assisted thoracic surgery for superior posterior mediastinal neurogenic tumour in the supine position
Video-assisted thoracic surgery (VATS) for a superior posterior mediastinal lesion is routinely done in the lateral decubitus position similar to a standard thoracotomy using a double-lumen endotracheal tube for one-lung ventilation. This is an area above the level of the pericardium, with the superior thoracic opening as its superior limit and its inferior limit at the plane from the sternal a...
متن کاملAnaesthetic implications of paediatric thoracoscopy
Anaesthetic care during thoracic surgical procedures in children combines components of the knowledge bases of paediatric anaesthesia with those of thoracic anaesthesia. This article highlights the principles of anaesthesia during thoracoscopic surgery in children including preoperative evaluation, anaesthetic induction techniques, maintenance anaesthesia and options for postoperative analgesia...
متن کاملDescending Necrotizing Mediastinitis: Review of the Literature and Controversies in Management
Any deep cervical infection has to be aggressively treated and CT scan of the chest should be performed to exclude the possibility of downward spread of the infection within the mediastinum. Early recognition of DNM is problematic because of its rarity and the non-specific symptoms in its early phase. DNM can rapidly progress to involve the entire mediastinum. Aggressive surgery upon diagnosis ...
متن کامل