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Awake palliative thoracic surgery in a high‐risk patient: one‐lung, non‐invasive ventilation combined with epidural blockade
Author(s) -
Guarracino F.,
Gemignani R.,
Pratesi G.,
Melfi F.,
Ambrosino N.
Publication year - 2008
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2008.05443.x
Subject(s) - medicine , lidocaine , anesthesia , ventilation (architecture) , video assisted thoracoscopic surgery , surgery , lung cancer , airway , lung , thoracotomy , mechanical engineering , engineering
Summary We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video‐assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient’s cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video‐assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one‐lung spontaneous ventilation in this high‐risk patient, we successfully used non‐invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non‐invasive lung ventilation.