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Cardiothoracic and Vascular Anesthesia
Anesthesia and Pain Medicine 2014;9(1):54-57.
Published online January 30, 2014.
A unilateral large bronchopleural fistula caused by rupture of bulla with coexisting bilateral giant bullae: A case report
Yong Oh Kim, Jong Hoon Yeom, Jae Min Lee, Jang Won Byun, Woo Jong Shin
Department of Anesthesiology and Pain Medicine, Hanyang University Guri Hospital, Guri, Korea. yeomjh@hanyang.ac.kr
Received: 27 September 2012   • Revised: 22 October 2012
Abstract
A patient with a large bronchopleural fistula presents several intraoperative challenges for the anesthesiologist, particularly if bullae coexist bilaterally. Ideally, a double lumen tube is inserted while the patient is conscious or breathing spontaneously under general anesthesia to prevent possible tension pneumothorax in the contralateral lung due to positive-pressure ventilation and the possibility of inadequate ventilation due to an air leak from the fistula. However, we inserted a single lumen tube instead of a double lumen tube, because this patient had multiple giant bullae bilaterally and the contralateral lung tissue was almost completely compressed and destroyed. We report the use of a single lumen tube under volatile general anesthesia with synchronized intermittent mandatory ventilation with small tidal volume. In addition, we used permissive hypercapnia to further minimize barotraumas. Due to permissive hypercapnia, there were no cardiovascular consequences.
Key Words: Bronchial fistula, Bullae, Hypercapnia, Synchronized intermittent mandatory ventilation
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