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[Anesthesia for lung volume reduction surgery].

G Della Rocca1, L Pompei, C Coccia

  • 1Azienda Ospedaliera Policlinico Umberto I, Istituto di Anestesia e Rianimazione, Università degli Studi La Sapienza, Rome, Italy. dellaroca@uniroma1.it

Minerva Anestesiologica
|May 31, 2001
PubMed
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Lung volume reduction surgery (LVRS) offers palliative benefits for advanced emphysema. Careful anesthesia and epidural analgesia during LVRS are safe and effective, improving patient outcomes.

Area of Science:

  • Cardiothoracic Surgery
  • Pulmonary Medicine
  • Anesthesiology

Background:

  • Lung volume reduction surgery (LVRS) is a palliative option for advanced non-bullous emphysema.
  • Severe emphysema patients require specialized anesthetic and surgical approaches.

Purpose of the Study:

  • To evaluate the safety and efficacy of a specific anesthetic technique during LVRS.
  • To assess the impact of thoracic epidural analgesia in LVRS patients.

Main Methods:

  • 24 patients with severe emphysema underwent LVRS with T5-T9 epidural catheter insertion.
  • One-lung ventilation (OLV) with adjusted settings and permissive hypercapnia (PaCO2=53 mmHg) was employed.
  • High-frequency jet ventilation was used when PaO2/FiO2 < 60 mmHg in 5 patients.

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Main Results:

  • No intraoperative complications related to hypercapnia occurred.
  • 23 of 24 patients were successfully extubated post-surgery.
  • Postoperative pain scores were low (≤2 on Keele scale), and 12-month data showed improved lung function (FEV1, FVC, RV) and 6MWT.

Conclusions:

  • A meticulous anesthetic technique with intraoperative monitoring and thoracic epidural analgesia is recommended for LVRS.
  • LVRS, when performed with this approach, demonstrates sustained validity and improved patient outcomes at 12 months.