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05:39
Non-Intubated Video-Assisted Thoracoscopic Surgery
Published on: May 26, 2023
Non-invasive ventilation corrects alveolar hypoventilation during spinal anesthesia
Martine Ferrandière1, Eric Hazouard, Jean Ayoub
1Department of Anesthesia and Critical Care, Regional University Hospital Center of Tours, Tours, France. ferrandiere@med.univ-tours.fr
Summary
Non-invasive ventilation effectively treated hypoxemia and hypoventilation in a patient with severe chronic obstructive pulmonary disease undergoing surgery. This intervention improved diaphragmatic excursion and respiratory function during spinal anesthesia.
Area of Science:
- Anesthesiology
- Pulmonology
- Critical Care Medicine
Background:
- Severe chronic obstructive pulmonary disease (COPD) poses significant respiratory challenges during surgery.
- Spinal anesthesia and the lithotomy position can further compromise respiratory mechanics, especially in patients with COPD.
Observation:
- A morbidly obese patient with severe COPD experienced hypoxemia and alveolar hypoventilation during prostate surgery under spinal anesthesia in the lithotomy position.
- Diaphragmatic excursion significantly decreased by 30% after anesthesia and positioning, confirmed by sonography.
- Ventilation/perfusion mismatching was also observed.
Findings:
- Non-invasive positive pressure ventilation (NIPPV) successfully corrected intraoperative hypoxemia and alveolar hypoventilation.
- NIPPV improved diaphragmatic excursion and overall respiratory function.
- The patient experienced reduced clinical discomfort with NIPPV.
Implications:
- NIPPV is a valuable tool for managing respiratory compromise in severe COPD patients during surgery.
- This case highlights the importance of monitoring and intervening in respiratory function under specific anesthetic and surgical conditions.
- Optimizing respiratory support can improve surgical outcomes and patient comfort in high-risk populations.
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