The effects of two lung ventilation, one lung ventilation and alveolar
lavage on right ventricular mechanics in a patient have been observed
using transoesophageal echocardiography (TOE). Alveolar lavage result
ed in additional stresses to those of one lung ventilation (OLV) and t
he point when these were noted to be resulting in right ventricular ch
anges was used as the signal to terminate the filling phase of a cycle
of alveolar lavage. A significant increase in right ventricle afterlo
ad occurred on starting OLV. The response to lung ravage was biphasic,
initially a further increase in afterload followed by a reduction in
preload. Because there was rapid adaptation to these changes, it was f
elt appropriate to perform sequential lung lavage during the same anae
sthetic. In similar circumstances where pulmonary vascular resistance
is changed, information obtained from TOE may be used to guide therapy
.