VIDEO-ASSISTED THORACOSCOPIC VOLUME REDUCTION SURGERY IN PATIENTS WITH DIFFUSE PULMONARY-EMPHYSEMA - GAS-EXCHANGE AND ANESTHESIOLOGICAL MANAGEMENT

Arterial blood gases were studied prospectively using continuous intra arterial blood gas monitoring during thoracoscopic volume reduction su rgery (VRS) in 24 patients with advanced diffuse pulmonary emphysema. Additionally, the early postoperative course (48 h) of arterial blood gases was studied retrospectively. Twenty-six operations were performe d using a combination of thoracic epidural and general anesthesia with left-sided double-lumen intubation for one-lung ventilation (OLV). Ar terial blood gases were determined awake, during two-lung ventilation prior to surgery, during OLV (extreme values), and after tracheal extu bation. Additionally, the extremes during the whole procedure were det ermined: avoiding excessive peak inspiratory pressures (26.4 +/- 7.0 c m H2O), minimum Pao(2) was 77 +/- 39 mm Hg (mean +/- SD), maximum Paco (2) 65 +/- 14 mm Hg (P < 0.0001 versus preoperative values), and minim um pH(a) 7.22 +/- 0.08 (P < 0.0001). One tension pneumothorax occurred during OLV. Immediate postoperative extubation was performed in 25 of 26 cases, reintubation was necessary in two cases. One patient with c oronary artery disease died 36 h after surgery. Hypercapnia (maximum P aco(2) 49 +/- 8 mm Hg, minimum pH(a) 7.37 +/- 0.04, P < 0.01) was stil l observed 48 h after surgery. These results demonstrate that adequate oxygenation can be preserved during OLV for VRS, but CO2 elimination is impaired. However, intraoperative hypercapnia and immediate postope rative tracheal extubation are well tolerated.