[Postpneumonectomy syndrome: several new anesthesiological and pathophysiological aspects]

As a result of 10-year investigations a concept of postpneumonectomy syndrome (PPS) has been defined as a combination of acute respiratory disturbances due to alteration of filtration and absorption functions of the lungs along with systolic and diastolic right heart dysfunction. The aim of the study was to identify the details of PPS pathogenesis dependent on the initial right chamber pressure levels and a search for probable approaches to PPS correction. The study was carried out on 26 patients subject to pneumonectomy. Central hemodynamics along with filtration and absorption lung functions and changes in extravascular lung water (EVLW) have been studied. According to the data obtained, initial pulmonary hypertension definitely plays a certain part in PPS pathogenesis; upon the administration of a Ca-blocker finoptin, the right heart condition was characterized by a significant increase in EF and EDV, followed by an increase in blood flow and a drop an PCWP; all the patients have experienced an increase in EVLW up to 7-8 ml/kg. Though altered right heart diastolic function may play a key role in hemodynamic and gas exchange disturbances, the application of Ca-blockers is believed to be a possible approach to the correction of the above deviations.