Anesthetic management of pulmonary lavage in adults

A 6-year experience in the anesthetic management of 34 successful whole-lung lavages on 11 adult patients with pulmonary alveolar proteinosis is described. All patients were radiographically, physiologically, and symptomatically improved after the procedures. The anesthetic protocol for lung lavage includes: (1) unilateral whole-lung lavages 2 to 4 days apart; (2) general anesthesia with the placement of a Carlens tube; (3) isotonic saline as the lavage solution; (4) mechanical chest percussion during lavage; (5) serial arterial blood-gas determination and measurement of lung compliance in the intraoperative and immediate postlavage period. The authors conclude that whole-lung lavage is a safe and effective palliative procedure in pulmonary alveolar proteinosis and in the treatment of patients with pulmonary disease, such as cystic fibrosis or asthma, in which filling of the lung acini by liquid or solid material impairs oxygenation of the pulmonary capillary blood.