HYPOXEMIA DURING one-lung ventilation (OLV) for video-assisted thoracoscopic surgery (VATS) is a difficult problem for the anesthesiologist to manage. The standard therapy recommended for this problem is the application of continuous positive airway pressure (CPAP) to the nonventilated lung. However, CPAP interferes with surgical exposure in the hemithorax. A novel technique to treat hypoxemia in this context using fiberoptic bronchoscopic segmental oxygen insufflation and recruitment that does not impede surgery is described.
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A Novel Method of Treating Hypoxemia During One-Lung Ventilation for Thoracoscopic Surgery. Ku CM, Slinger P, Waddell T. J Cardiothorac Vasc Anesth 2009, 23: 850-2
Predictors of Prolonged Postoperative Endotracheal Intubation in Patients. Cywinski JB, Xu M, Sessler D, et al. J Cardiothorac Vasc Anesth 2009, 23: 766-9
Objective: The aim of this study was to identify predictors
of delayed endotracheal extubation defined as the need for
postoperative ventilatory support after open thoracotomy
for lung resection.
Design: An observational cohort investigation.
Setting: A tertiary referral center.
Participants: The study population consisted of 2,068 patients
who had open thoracotomy for pneumonectomy, lobectomy,
or segmental lung resection between January
1996 and December 2005.
Interventions: Not applicable.
Measurements and Main Results: Preoperative and intraoperative
variables were collected concurrently with the patient’s
care. Risk factors were identified using logistic regression
with stepwise variable selection procedure on 1,000
bootstrap resamples, and a bagging algorithm was used to
summarize the results. Intraoperative red blood cell transfusion,
higher preoperative serum creatinine level, absence of a
thoracic epidural catheter, more extensive surgical resection,
and lower preoperative FEV1 were associated with an increased
risk of delayed extubation after lung resection.
Conclusion: Most predictors of delayed postoperative extubation
(ie, red blood cell transfusion, higher preoperative serum
creatinine, lower preoperative FEV1, and more extensive
lung resection) are difficult to modify in the perioperative period
and probably represent greater severity of underlying lung
disease and more advanced comorbid conditions. However,
thoracic epidural anesthesia and analgesia is a modifiable factor
that was associated with reduced odds for postoperative
ventilatory support. Thus, the use of epidural analgesia may
reduce the need for post-thoracotomy mechanical ventilation