[Severe hypoxia during right lateral position induced by mediastinal shift].

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Radiology

Background:

• Total hip arthroplasty is a common orthopedic procedure.
• Patient positioning during anesthesia can impact respiratory mechanics.
• Osteoarthritis necessitating hip replacement is prevalent in the elderly population.

Observation:

• An 87-year-old female patient experienced decreased oxygen saturation and absent breath sounds in the right lung during right lateral positioning for hip surgery.
• Bronchofiberscopy confirmed appropriate tracheal tube placement and absence of secretions.
• Immediate improvement in oxygenation and breath sounds occurred upon returning the patient to a supine position.

Findings:

• Chest X-rays revealed significant right lung volume reduction in the right lateral position, attributed to extreme downward mediastinal shift.
• The mediastinal shift was less pronounced when the patient was awake in the right lateral position.
• The patient's surgery was postponed and later performed successfully in the supine position.

Implications:

• Extreme downward mediastinal shift can cause severe lung volume reduction in the lateral decubitus position under anesthesia.
• Careful patient positioning and respiratory monitoring are crucial in patients undergoing surgery in lateral positions.
• Preoperative assessment and intraoperative vigilance are necessary to mitigate risks associated with positional changes during anesthesia.