ANESTHETIC MANAGEMENT OF PATIENTS UNDERGOING UNILATERAL VIDEO-ASSISTED LUNG REDUCTION FOR TREATMENT OF END-STAGE EMPHYSEMA

Objectives: Nonanatomic resection of peripheral areas of lung is being performed via sternotomy for the treatment of end-stage emphysema. Re cent technologic advances have allowed the resection of lung tissue us ing video-assisted thoracic surgery (VATS) techniques. The study was p erformed to document the physiologic changes that occur during unilate ral VATS lung reduction in hopes of determining appropriate monitoring and intraoperative management strategies. Design: Prospective trial o f unilateral VATS lung reduction. Setting: Tertiary care university ho spital. Participants: Twenty patients with end-stage emphysema. Interv entions: Participants underwent unilateral VATS lung reduction. Measur ements and Main Results: Invasive hemodynamic monitoring was performed using radial and pulmonary artery catheters. Hemodynamic and respirat ory gas exchange data were collected at four intraoperative points: (1 ) supine, two lung ventilation; (2) lateral decubitus, two-lung ventil ation; (3) lateral decubitus, one-lung ventilation, and (4) end of sur gery, supine, two-lung ventilation. Data were compared with that colle cted at the first point. Patients tolerated lengthy surgical procedure s and remained hemodynamically stable with no episodes of hypoxemia re quiring treatment. Extubation was tolerated by 19 of 20 patients at th e conclusion of surgery without further requirement of mechanical vent ilation. Conclusions: VATS lung reduction under general anesthesia wit h one-lung ventilation is well tolerated. Permissive hypercapnia was w ell tolerated by all patients. Early extubation can be routinely accom plished in these patients. Copyright (C) 1996 by W.B. Saunders Company