[Successful one-lobe ventilation in a patient combined with multiple bulla and interstitial pneumonia]

Respiratory management of interstitial pneumonia during general anesthesia is challenging, especially for one-lung ventilation. We report the successful left-side one-lung ventilation after left lower lobectomy. A 79-year-old man with interstitial pneumonia was scheduled for right side bulla resection. After epidural anesthesia at T8-9, under dexmedetomidine and propofol sedation and regional anesthesia with lidocaine, a double-lumen tube was inserted with a Macintosh laryngoscope preserving spontaneous breathing. Next, we continuously administered propofol at 1.5-2.0 microg x ml(-1) in target-controlled infusion manner, 0.8 microg x kg(-1) x hr(-1) dexmedetomidine and 50 mg x hr(-1) aminophylline for minimizing hypoxic vasocontriction. The bispectral index was maintained within 40-60 by titrating the dose of propofol. Analgesia was performed with epidural 100 microg fentalyl and 6 ml of 0.375% ropivacaine administration. The lowest Spo2 during one-lobe ventilation was 88% which recovered to 97% by oxygen administration to right lung with no pressure. We could keep about 3-4 l of minute volume and accumulation of Paco2 was acceptable. The patient was under one-lobe (left upper lobe) ventilation with spontaneous breathing during the operation. Open bulla resection was performed uneventfully. There were no complications from one-lobe ventilation and the patient was extubated in the operating room. One-lung ventilation, which preserves spontaneous breathing is considered effective for preventing barotrauma in patients with interstitial pneumonia. Dexmedetomidine as well as propofol or aminophylline may be effective avoiding hypoxic vasoconstriction. Furthermore, we could perform one-lobe ventilation with left-upper lobe with maintaining sufficient oxygenation and ventilation.