Lateral thoracotomy and one-lung anesthesia in patients with morbid obesity

Between May, 1980, and October, 1981, 22 morbidly obese patients ranging in weight from 93.4 to 236.8 kg (average, 145.2 kg) underwent transthoracic gastric stapling. Fourteen of these operations were performed using endobronchial intubation and selective collapse of the left lung to facilitate surgical exposure. The patients were compared with 22 consecutive patients treated by trans-abdominal gastric stapling during the same period. None of the 44 patients had evidence of chronic alveolar hypoventilation (pickwickian syndrome). In terms of operating time, blood loss, duration of intubation, and hospital stay, the two groups did not differ significantly. Despite marked shunting during one-lung ventilation, satisfactory arterial oxygen tension (PaO2) could be demonstrated on 100% oxygen for all thoracotomy patients (PaO2 range, 67 to 230 torr; mean, 132.3 torr). In fact, except for a lower PaO2 during one-lung anesthesia, the thoracotomy patients were indistinguishable from the laparotomy patients in terms of perioperative respiratory function. Pain, sedation, and positioning led to significant decreases in vital capacity and one-second forced expiratory volume in both groups on the first post-operative day, and in the thoracotomy group on the second day. There were only two wound infections in the thoracotomy group, as opposed to six infections with two dehiscences in the laparotomy group. It is concluded that lateral thoracotomy with or without one-lung anesthesia can be performed safely in massively obese patients--at least in those without preexisting alveolar hypoventilation syndrome.